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Background/Purpose: Virtual dissection is performed with CT scans on near life-size touchscreens, which function like hospital radiology workstations. Students work together to manipulate the data and perform their dissection. The purpose of this study was to develop and qualitatively assess the educational value of virtual dissection laboratories for first year medical students as well as to understand students' preferred pedagogical approaches for learning from this new technology. Methods: 105 first-year medical students participated in a case-based virtual dissection curriculum and were invited to complete a theory-based post-experience survey. Eight unique cases were selected based on the first-year curricular objectives and in groups of 6-8, students reviewed the cases with a radiologist. First, students' reactions to virtual dissection were measured by three constructs using a 5-point Likert scale: quality of curriculum design (11 questions), impact on learning (7 questions), and comfort with technology (3 questions). Second, students ranked the usefulness of six pedagogical approaches for this technology. Responses were tabulated and rank order item lists were generated statistically using the Schulze method where appropriate. Results: The survey response rate was 83% (87/105). Overall, students' reactions to virtual dissection were positive across all three measured constructs. Most students indicated that the cases were of an appropriate level of difficulty (90%) and that virtual dissection improved their understanding of disease and pathology (89%), the clinical relevance of anatomy (77%), and visuospatial relationships (64%). Almost all students (94%) reported that the curriculum improved understanding of the role of the radiologist in patient care. Students felt that the “very useful” pedagogical approaches were small group demonstration (68%) and problem-based learning (51%). Conclusion: First-year medical students perceive virtual dissection as a valuable tool for learning anatomy and radiology. This technology allows real-life clinical cases to be introduced into pre-clinical learning, thereby providing opportunities to strengthen the vertical integration in medical curricula., Background/Purpose: The Doctor of Medicine Undergraduate Program (MDUP) at the University of British Columbia has employed anatomy procedure videos to prepare students ahead of attending gross anatomy laboratory sessions. The theory is that students who watch these video tutorials will be better prepared to maximize learning from the laboratory sessions, thus using this time more effectively to achieve learning outcomes. This project produced a video to support the MDUP video series, offering a gross anatomy laboratory dissection guide to outline and present significant anatomical and physiological components of the chest and lungs. Through student survey feedback, we determined the usefulness of videos in helping students achieve anatomy learning objectives and which areas of the videos were most helpful in doing so. If successful, the content of this video production can also be incorporated into the curriculum of other disciplines (healthcare related or otherwise) including, but not limited to, the physical therapy programs, doctor of dental medicine (DMD) programs, bachelor of nursing programs (BSN), and undergraduate physiology and kinesiology degree programs. Summary of the Innovation: A series of anatomy video tutorials were uploaded to an official UBC FLEX YouTube account between 2017 and 2019. Survey results were collected and collated. Medical student feedback was overwhelmingly positive as most participants found the videos to be effective in achieving learning outcomes. Conclusion: This study serves as a foundation for future work in the development of multimedia to teach anatomical sciences. The content of these video productions can be incorporated into the curriculum of other disciplines (healthcare related or otherwise)., Background/Purpose: Radiology aids patient diagnosis and management. All physicians should be able to provide preliminary interpretations of imaging studies. Thus many medical undergraduate programs are integrating radiology into anatomy curricula to better prepare students for clinical practice. To date, no research has assessed the ideal balance between cadaveric and radiologic content in anatomy teaching. This study aims to assess undergraduate medical students' (“UMS”) comfort level in identifying cadaveric and radiologic anatomy, and to identify areas where curricula can be renewed. Methods: An anonymous online survey was sent to years 2-4 UMS at a large distributed medical school teaching cadaveric and radiologic anatomy. Respondents' demographic information and prior radiology exposure was collected. UMS ranked their comfort level in identifying cadaveric and radiologic anatomy on a 4-point Likert scale. Statistical analysis was done to determine any difference in responses by stage of training. Copeland score method generated a rank-order list of UMS comfort level across all variables. Results: 153 UMS did the survey (response rate 18%). Respondents: 50.3% female; 51.6% in clinical years; 90.8% reported no radiology teaching before medical school; 65.4% rated their overall anatomy knowledge as “average.” Likert data showed UMS felt most comfortable with identifying cadaveric anatomy (organs, bones, spatial relationships) and least comfortable with radiologic anatomy (pathology, neuroanatomy, spatial relationships). No statistical difference with training level. Conclusion: UMS reported feeling less comfortable with identifying anatomy on radiologic studies compared to the same structures in cadavers. This study suggests that UMS would benefit from more exposure to radiology anatomy during medical school., Background/Purpose: Learning materials provided to students prior to anatomy dissection labs have classically been in the form of written instructions and images from prosections. However, these materials can be difficult to interpret, especially for beginner students. With the advancement of technology, educational curricula are exploring the integration of digital platforms to supplement more traditional teaching methods. The aim of this project was to investigate the utility of a video-based guide for approaching dissection. Summary of the Innovation: A video dissection guide was created demonstrating the dissection of the superficial back. The video outlines anatomy, technique, procedure, and includes review questions. The video was made available online through YouTube, along with a feedback survey. Conclusion: After one month, the video has received more than 1,000 views. Feedback was received from 65 respondents; a majority of whom were female (63.1%), aged 20-24 (58.5%), and had a current education level of a postgraduate degree or professional degree (53.8%). The majority of respondents agree or strongly agree that the video presented the anatomy in a clear and organized fashion (95.4%), enhanced their learning of the anatomy (100%), familiarized them with dissection tools and how to use them (89.2%), familiarized them with methods and techniques for dissection (92.3%), was more effective than a dissection guide (96.9%), and was more effective for learning anatomy than a textbook (87.7%). A poll of fifty-one respondents found that most agree or strongly agree that the video is a valuable resource for review/test preparation (88.2%). In summary, digital media in the form of video-based dissection guides may be a useful tool to incorporate into educational curricula for teaching gross anatomy., Background/Purpose: Virtual dissection is a novel teaching method using radiological images to study human anatomy. We aimed to determine the educational value and student satisfaction with a peer-to-peer teaching model using this emerging technology Summary of the Innovation: Second year medical students prepared and taught virtual dissection laboratories to first-year students, which were voluntary and extra-curricular. The case-based laboratories were designed to expose participants to clinical radiology. Participants completed a post-laboratory survey based on the Kirkpatrick Hierarchy for curriculum evaluation. Conclusion: Thirty-four first year students (24 females, 10 males) participated in this laboratory. All respondents found the cases were presented an appropriate level of difficulty, with 94% of participants believing the peer tutor facilitated the session effectively. Upon completing the session, the majority of participants felt that they understood the imaging findings (88%), clinical cases (91%), and perceived the session as a valuable learning experience (97%). Participants agreed or strongly agreed that the sessions improved their understanding of anatomy (97%) and disease (85%), the appearance of normal (94%) and pathological (97%) structures, and visuospatial relationships (91%). Almost all participants (97%) agreed or strongly agreed that the session was a valuable learning experience with a majority preferring the small group format versus large group teaching. In summary, students reported that peer-to-peer teaching was a valuable learning experience in virtual dissection laboratories. Peer-to-peer based virtual dissection laboratories provide an innovative and collaborative mode of learning that can complement more traditional anatomy education methods., Background/Purpose: Radiology integration into medical anatomy programs is well established, but there is a paucity of literature on integrating virtual dissection into cadaveric dissection laboratories. Virtual dissection is the digital dissection of medical images on touchscreen anatomy visualization tables. The purpose of this pilot study was to investigate the feasibility of integrating virtual dissection into a first-year medical cadaver-based anatomy course and to assess students' overall attitude towards this new technology. Methods: All students in first-year medicine at a single medical school participated in this study (n = 292). Six virtual dissection laboratories, which focused on normal anatomy, were developed and integrated into a cadaver-based anatomy course. The virtual dissection table (VDT) was also integrated into the final anatomy spot exam. Following the course, students completed a short evidence-informed survey which was developed using a theoretical framework for curriculum evaluation. Numerical data were tabulated, and qualitative content analysis was performed on students' unstructured comments. Results: The survey response rate was 69.2% (n = 202/292). Most (78.7%) students reported that virtual dissection enhanced their understanding of the cadaveric anatomy and the clinical applications of anatomy. Most (73.8%) students also felt that the VDT was an effective use of the laboratory time. Thirteen narrative comments were collected, most of which (61.5%) identified strengths of the curriculum. Conclusion: In this pilot study, students perceived that their learning was enhanced when virtual dissection was combined with a traditional cadaver-based anatomy laboratory. This study demonstrates that there is potential for virtual dissection to augment cadaveric dissection in medical education., Background/Purpose: The advances in technology have allowed teachers to develop new ways to teach their course materials to their students. This has ranged from using educational videos to developing online learning modules that students may complete at their pace and time. Although these advances in enhancing student knowledge have been made in many subjects, there are limited resources available to students for the purposes of learning anatomy. One area that needs to be expanded is one of educational anatomy video tutorials/lessons. This project was designed to create an educational video tutorial/lesson that provides a step by step tutorial that the students can follow to complete their anatomy lab. The video is designed to complement the lab component rather than replace it as we have realized that there is no substitute for viewing the material first hand. The video would allow students to prepare for the lab and upon its completion, they may refer back to the video and use it as a study tool. Methods: To begin the cadaver was dissected and prepared so that the anatomical structures that needed to be identified were properly exposed for the filming. The filming was done through a stepwise manner, where the anatomical structures were identified and commented on throughout the video. During the editing, process animations were added to tag key anatomical structures and a quiz was added towards the end to allow students to test their knowledge on the materials in the video. Results: To gather the efficacy of the videos and receive feedback we gave the students a survey to conduct prior to and after their lab. The results showed that more than 95% of students felt that the video helped them prepare for the upcoming lab dissection. While 98.9% of students felt that they would like to have a similar lab video for labs in the future. Also, 93% of the students stated that they would like to use the videos to study for their exams. Conclusion: Due to the positive responses received it can be concluded that the use of video tutorials in teaching anatomy is an effective tool that can be implemented alongside the lecture material and cadaver dissections to enhance the learning of students., Background/Purpose: MUN Medicine's Opioid Awareness and Support Team (OAST) is a student run organization created in 2017. OAST's objectives are to address knowledge gaps among students and the community surrounding opioid use and treatment. One central tenant is to focus on service learning, where students engage with community partners for bilateral learning and mutual benefit. Summary of the Innovation: OAST has engaged three different community organizations to both provide students with increased knowledge of opioid use/harm reduction as well as disseminate important information to the community. OAST's partnership with the local Safe Works Access Program (SWAP) provided students information about harm reduction to students and Naloxone training sessions, while students worked with SWAP to pack harm reduction kits. Student feedback and reflection indicates increased awareness and understanding of harm reduction. Second, in partnership with a local organization for marginalized youth, we developed and delivered Opioid Awareness Workshops. Surveys following the workshops indicates that the need for information was met. Lastly, OAST partnered with the local penitentiary to discuss opioid related health issues with incarcerated individuals. We will deliver our workshop to staff at the penitentiary in the future and work with other community organizations who identify a similar need for information. Conclusion: OAST has provided students will novel service learning opportunities as well as connected community organizations with informed students to teach on a critical public health topic. Follow up with community partners indicates positive responses regarding impact and mutual benefit. OAST is an example of a student led initiative in community partnership that is knowledge driven and strengthens capacity at the local level., Background/Purpose: Social accountability (SA) is central to medical education. While many institutions strive to be accountable to the communities they serve, the extent to which programs meet societal needs remains largely unknown. Part of this problem may be a result of the operational complexities surrounding SA. This paper provides the initial operational concepts needed to evaluate SA in medical training through reviewing and synthesizing SA policies. Methods: Thematic synthesis was used to identify operational concepts from large-scale, public SA policies. Common and unique elements across policies were thematically coded using context-input-process-products (CIPP) evaluation model as an organizational framework. Results: Out of an initial sample of 32 documents, four large-scale SA policy frameworks were selected and analyzed. Sub-policies and/or program/institution specific documents were excluded from the analysis as they build upon previous frameworks and may lack generalizability. Emerging themes highlighted across policies included core social values. These values were expected to be displayed across the training continuum. Sub-themes under each CIPP domain included: context (public display of institutional goals/mandates, collaborative partnerships with health systems, contribution to health policy); inputs (diversity/equity in recruitment/selection, community health profiles); processes (curricular activities, learning opportunities/exposure); products (physician resource planning, quality assurance, evaluation/accreditation) and impacts (improve community health, reduce/prevent health risks, morbidity/mortality). Conclusion: Using an evaluation framework, this paper provides a thematic synthesis of key SA frameworks. Findings from our analysis revealed major themes consistent to the broader literature. However, this paper operationalized a set of performance indicators that can be used to guide programs evaluate SA., Background/Purpose: The “Social Determinants of Health” (SDoH) is the term for the factors that impact the emotional and physical wellbeing of patients. These factors contribute greatly to inequity of patient healthcare experiences. Yet, many healthcare professionals do not recognize the unique life circumstances of their patients, or how such circumstances warrant different treatment approaches. The World Health Organization, the Association of American Medical Colleges, and the Royal College of Physicians and Surgeons of Canada, among others, have identified the importance of teaching medical trainees how to act on the SDoH to effectively care for patients. Methods: This poster reviews literature on programs for teaching social medicine. It then outlines the best practices for teaching medical learners how to account for the SDoH when delivering patient care. MEDLINE at OVID, Embase, and Cinahl Plus were searched for the terms: “Social Determinants of Health,” and “teaching,” or “students, medical/ students, health occupations” with no age, publication date, or language restrictions. Teaching strategies from relevant articles were discussed with Toronto-based physicians for their input. Results: A curriculum for SDoH-based teaching techniques to enact meaningful change in the provision of care was developed and is discussed in this poster. The literature identifies that, despite the growing number of programs addressing SDoH in their medical curricula, the programs do not adequately teach medical learners how to address the influence of the SDoH on the patient when delivering care at the bedside. Conclusion: Accordingly, the curriculum guidelines in this poster have been developed to address this gap in the education of medical students - to ensure that a patient's social circumstances inform their treatment., Background/Purpose: L'incohérence entre la demande de soins de santé de la population vulnérable et l'accès offert par la communauté médicale est inconcevable. Pour les étudiants, la création de liens avec cette clientèle est confrontante. Les préjugés peuvent nuire à la qualité de la relation, alors que cette dernière est essentielle à une démarche de soins efficace et inclusive. L'initiative étudiante « Voisins de la rue » offre l'opportunité d'aborder la réalité complexe des populations vulnérables dans un contexte sécurisant et encadré. Non seulement ce projet permet de valoriser la responsabilité sociale du futur médecin; mais il contribue à développer l'autonomie et l'estime personnelle chez les personnes marginalisées de Trois-Rivières, étant l'une des dix villes les plus pauvres au Québec. Summary of the Innovation: En septembre 2017, trois étudiantes de l'UdeM au campus décentralisé de la Mauricie ont d'abord collaboré avec les intervenants d'organismes communautaires locaux. Ensemble, ils ont identifié les besoins des usagers et créé des activités rejoignant des objectifs variés : art, cuisine, musique, relaxation et jeux. Annuellement, chacune des 7 activités, où la communication est priorisée, permet d'établir des liens significatifs entre 5 à 8 étudiants et un même nombre de participants marginalisés. De plus, une collecte de dons est effectuée à chaque Noël pour les gens en situation d'urgence. À ce jour, 17 % des étudiants entre l'année préparatoire et la fin du préclinique ont participés. Conclusion: Au quotidien, les étudiants sont sensibilisés à la réalité des personnes vulnérables et peuvent adopter une approche médicale personnalisée et collaborative. En diffusant cette initiative au Canada, l'importance d'un accès aux soins égal pour tous sera mis de l'avant., Background/Purpose: Despite widespread acceptance of advocacy as a professional obligation over recent years (Frank, 2005), teaching and evaluating health advocacy has been challenging (Poulton & Rose, 2015). Service learning has emerged as a valuable educational tool for fostering knowledge and skills in community health and raising awareness of social determinants of health amongst medical trainees (Buckner, 2010). Despite this, medical schools continue to be challenged in finding ways to effectively incorporate service learning and advocacy into their curriculum and measure the outcomes of those initiatives on training physicians as health advocates. Through our study, we aimed to identify current educational strategies and research gaps in fostering advocacy amongst medical students and residents in the context of community-based service learning (CBSL). Methods: Scoping review procedures were applied to systematically search, screen, extract and synthesize this broad body of literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: Ten key themes related to strategies and approaches to advocacy education were identified within 68 selected publications: (a) geographic location b) community partners (c) community populations served (d) program participants (e) program format (f) evaluation (f) data analysis (g) results and student outcomes (h) sustainability (i) challenges and limitations. Conclusion: This scoping review provided key insights into a variety of CBSL advocacy program formats, evaluation methods, and outcome measures which can be used as a framework for establishing sustainable programs aimed at fostering advocacy amongst medical trainees. A list of recommendations for future areas of inquiry is also provided to guide future research., Background/Purpose: Muslims represent the second largest religious group in Canada. Western Muslim patients share religiously informed healthcare values. The inadequate assessment of cultural needs has been shown to contribute to a lower quality of care for Muslim patients in Western countries. Studies have shown that cultural competence training is associated with improved cultural competence of healthcare providers, increased patient satisfaction and reduction in health disparities for priority populations. This study aimed to assess the effectiveness of a didactic-style symposium at improving the cultural competence of healthcare trainees in the care of Muslim patients. Methods: 44 healthcare trainees from Queen's University attended a three-hour symposium on topics related to caring for Muslim patients. Students completed a modified version of the cultural competence self evaluation (CCSE) form pre- and post-symposium. Descriptive statistics were calculated using means (SD) for continuous variables and frequencies (%) for categorical variables. Students' pre and post-CCSE scores, and the score's three sub-components were compared with a paired t-test. Results: The average CCSE (out of 80) was 36 ± 9.03 pre-, and 49.71 ± 10.84 post-symposium. Participants improved a mean of 13.71 ± 8.34 points on the CCSE (p, Background/Purpose: In 2015, The Truth and Reconciliation Commission (TRC) of Canada released a report to inform all Canadians about the truth of Indian Residential Schools. Along with this report, “Calls to Action” were created to advance the process of Canadian reconciliation, including actions related specifically to health. One of the “Calls to Action” asks for medical students to take a course dealing with Indigenous health, including the history of residential schools. Hence, it is clear that the need for medical students to understand the history of residential schools is vital to addressing health disparities seen among Indigenous peoples today. Unfortunately, many medical students in Canada are not aware of this full history, and have not read the report put forward by TRC. Therefore, a TRC Report Reading Group for medical students has been created at the University of Toronto, as a student-led initiative, which is the first of its kind to be introduced in Canadian medical schools. Summary of the Innovation: The goal is to create, implement, and evaluate a TRC Reading Group to 1) inform medical students of the truth behind Indian Residential Schools to help reduce health inequities seen among Indigenous peoples and 2) address the “Calls to Action” released by the TRC. In collaboration with First Nations' House, the Medical Society's Global Health Portfolio, and the Office of Indigenous Medical Education at the University of Toronto, a TRC Report Reading Group was created. The TRC Reading Group was conducted over three sessions each lasting an hour, at which an Elder was present to facilitate. Medical students were asked to read certain sections of the 500-page Executive TRC Summary report prior to each session. During each session, reflective discussions on the contents of the report occurred, as well as a discussion on future steps medical students and physicians can take to provide the best care to Indigenous patients. Furthermore, an iterative process was used to develop these sessions, meaning that the content and discussion of the group was adapted over the course of the three sessions. This was done by ensuring there was feedback from both the Elder and students to help guide how each session would run. Conclusion: There is a critical need for learning about Indigenous health through experiential and reflective pedagogical techniques. Examples include a blanket exercise and learning from Elders. Ultimately, the TRC Reading Group is another approach where medical students can safely and deeply consider the experiences of Indigenous Peoples of Canada and their future roles of addressing Indigenous Peoples' ongoing inequities in healthcare., Background/Purpose: In medical education the learner environment has been identified as an area for improvement. Environments where mistreatment exists can have negative consequences for learning. For instance, if learners do not feel safe to speak up, if they are fearful of being humiliated by someone in a position of power, or if they have concerns about negative career consequences. Mistreatment can also limit learners in reporting patient safety issues therefore, silence and self-censorship may have serious consequences. This study sought to identify medical learners' comfort level in speaking up to faculty members, nurses, residents, administrators and patients. Methods: A cross-sectional online survey targeted 440 UGME learners at the University of Manitoba, (32% participation rate). After data editing, a logistic regression analysis was conducted on a sample of 123 learners. Results: Male learners were more comfortable then female learners in speaking up to faculty members (OR=4.5), nurses (OR=2.6), residents (OR=2.4) and administrators (OR=4.8). Caucasian learners were more comfortable speaking up to administrators (OR=2.8) than racialized learners. First generation learners were less comfortable speaking up to both patients (OR=-2.9) and residents (OR=-2.9). Conclusion: This study showed that women learners, racialized learners, and first-generation learners were less likely to be comfortable speaking up to positions of power. Given the increasing diversity of medical learners and the importance of speaking up regarding mistreatment, this is an important finding. It suggests a need for interventions to increase learner comfort with speaking up, and to address the conditions leading to the observed gender disparity., Background/Purpose: The Edmonton Frail Scale (EFS) is a multidimensional tool for assessing frailty, that both produces a single score reflective of a patient's overall frailty status and identifies specific aspects of frailty that warrant follow up. Over the past two years, steps have been taken to prepare the EFS for implementation in clinical settings, including the creation of a training video and an “EFS Toolkit” to train health care professionals to administer the EFS. The next step in implementation was to create a training course. Summary of the Innovation: Our final product is a 12-module training course, with accompanying practice activities and a simulation-based final assessment to assess the trainee's ability to administer the EFS in a home care setting. Using the educational framework of Backward Design, we mapped out course content and assessment. We then utilized Kane's framework to validate the simulation-based assessment. We conducted six feedback sessions with care providers to ensure that course instruction is understandable, and that the simulation reflects an authentic patient encounter. Conclusion: The success of this innovation was the result of strong grounding in conceptual frameworks in a collaborative environment. The Backward Design framework helped us align the course content and assessment with our course objectives, and Kane's framework helped us provide validity evidence for the assessments. Our project was also enhanced by the collaborative work environment in the University of Alberta's Faculty of Medicine and Dentistry Academic Technologies studio, where educators, medical students and designers take advantage of complimentary but very different expertise., Background/Purpose: Family physicians must maintain competence over a broad range of topics to ensure quality care for their diverse populations. Continuing professional development (CPD) courses provide one avenue for family physicians to stay up-to-date in their knowledge and skills. Curriculum mapping is a useful way to analyze the course offerings and determine to what extent the objectives align with the vast array of competencies required of family physicians. The map can be used by planning committees as part of their needs assessment process. Methods: Using Microsoft Excel, we compiled a total of 547 individual presentations from the 36 different CPD courses that took place between 2017-2019. We mapped these courses to a list of competencies for family physicians developed by consensus of stakeholders. We assigned a single point to each time a competency was addressed in a presentation's learning objectives. Analysis of these results was done to inform future planning. Results: Among the 547 presentations reviewed, competencies met most often were within the broad and overlapping categories of “Care of the Adults” (85.9%) and “Family Medicine Expert” (90.4%). Competencies met the least often were mapped to the categories of “End-of-life-care” (0.9%) and “Maternity and Newborn care”(2.4%). Within the nonmedical expert CanMEDs categories Health Advocate (4.9%) and Professional (5.7%) were lowest. Conclusion: Curriculum mapping is a useful tool to identify gaps in competencies. This can be used as a guideline when designing learning objectives for future CPD courses. The results can also facilitate reflection on why some competencies are over or under-emphasized., Background/Purpose: Understanding the impact of social determinants of health in paediatrics is essential to caring for children and in turn, to training in paediatric and primary care. Further, the attitudes with which physicians deliver care can be as therapeutically important as the medical treatment they provide (Markakis et al., 2000). While there is a lack of evidence for how to best teach such integral concepts, there is rising opinion that successful curricula development in this area will require a fundamental change in medical education (Sharma et al., 2018). We identified gaps in teaching Social Pediatrics in our pediatric residency program through faculty consultation, curriculum mapping and resident focus groups. Thematic analysis identified challenges and opportunities to learning social pediatrics related to personal/ learner factors and structural/systemic factors. Summary of the Innovation: Funded through an AMS Phoenix Fellowship grant, we implemented a 3-year longitudinal social pediatrics curriculum that is woven within our paediatric residency training program. The curriculum is delivered through (1) academic teaching; (2) community experiences; (3) independent learning modules and (4) a hands-on Advocacy Project. Our curriculum aims to move beyond our traditional approach of teaching social determinants, towards cultivating competency in health advocacy and compassionate care. Conclusion: Our curriculum has been implemented and resident feedback monitored. New approaches to physician culture, identity and bias are encouraged by this curriculum, which, through community engagement and experiential activities, challenges traditional physician-to-physician models of didactic teaching and learning. We outline the pedagogical principles that guided curriculum development, highlight key decisions made and challenges navigated to sustain change., Background/Purpose: The 'One Room Schoolhouse' (ORS) curriculum represents a radical shift in the model of teaching and learning for psychiatry residents. Residents identified that the current academic curriculum was most often taught in isolation, lacking integration with clinical training experiences. By reconstituting the learning group and incorporating a number of pedagogical innovations anchored to a clinical case, ORS attempted to address these concerns. Summary of the Innovation: Six residents across all training levels voluntarily formed a learning group to participate in the pilot project. A lead resident was responsible for generating a complex clinical scenario, followed by group objective setting. Learning occurred over 3 iterative sessions as compared to stand-alone traditional academic sessions. Pedagogical techniques included the incorporation of test-enhanced learning, a flipped classroom approach, concept integration exercises, and experiential learning linked to community settings. Data was collected to measure levels of satisfaction and change in knowledge using pre-post testing. A focus group was conducted to gather narrative feedback. All residents indicated that they would participate in future sessions despite the increase in workload. A number of focus group themes emerged including the link between accountability and learner engagement and the importance of a safe learning environment. Conclusion: There is preliminary evidence to guide postgraduate educators in building a successful academic curriculum through the work of the ORS, which engages novel pedagogical efforts and promotes a learning environment that fosters psychological safety, resident initiative and engagement, as well as formative assessments that facilitate reflective learning., Background/Purpose: Currently, the Royal College of Physician and Surgeons of Canada (RCPSC) is in the process of rolling out its model of outcome-based medical education dubbed “Competence By Design” (CBD). As each residency program transitions to CBD, they must review their entire curricula to reflect new sets of competencies and incorporate novel assessment tools. This process involves re-structuring a complex curriculum framework, which can be aided by curriculum mapping. A description of how a residency program can go about mapping all of the RCPSC outcomes and competencies to create a blueprint that coordinates the characteristic residency learning opportunities and their corresponding ideal assessment methods would be a helpful guide in this challenging process. Thus far, no such process has been described in the literature. The purpose of this project was to create an outcome-based curriculum map of Memorial University's pediatrics residency program. The process used to create this map was then extrapolated to describe a general model to curriculum mapping an entire residency program to ensure compliance with outcome or competency-based medical education. Methods: We systematically “mapped” the required RCSPC outcomes for our specialty to the learning opportunities available in our program. We first created individual maps for each of the clinical rotations in our residency program. The individual maps were cross-referenced and compiled to create a master program map using spreadsheet software. The master program map was then analysed for gaps and redundancies to inform a review of the curriculum as well as the creation and implementation of outcome-based assessment processes for each learning opportunity. Following completion of this mapping and curriculum review, our process was evaluated and generalized to create a model that other programs could follow. Results: Through the creation and evaluation of our curriculum map, we were able to identify a large number of RCPSC outcomes that were missing from our curriculum. To address these gaps, we revamped our academic half-day curriculum to systematically address outcomes over the course of a 3-year rota, and created new curriculum components including required advocacy projects and quality improvement initiatives. We also developed assessment tools to specifically evaluate whether or not each learning opportunity fulfilled its intended outcomes. Finally, a ten-step general model for curriculum mapping a residency program was developed through evaluation of the process we used to create our program's map. Conclusion: Curriculum mapping can be a powerful tool when used to evaluate the curriculum of an entire residency program, especially in this shifting environment of outcome- and competency-based medical education. We have created a simple ten-step model to evaluate a residency program through curriculum mapping. By using the model that we have presented, a residency program will be able to create a comprehensive outcome-based curriculum complete with assessment processes, which reflect all of the required learning outcomes and competencies expected of their residents upon completion of the program., Background/Purpose: In 2016, the University of Manitoba Pediatrics Residency launched a 4-week Academic Skills & Knowledge (ASK) rotation for first year residents (PGY1). Topics included statistics, research design, and critical appraisal. The goal of this study was to evaluate ASK to assess the rotation's value and facilitate revisions. Methods: In 2017, pre- and post-ASK focus groups assessed resident goals and feelings about the rotation. Written exams before (time0) and immediately after (time1) the rotation assessed knowledge gains (2016-2018) and retention (time2, 6mo post-ASK, 2017-2018). PGY1s in each ASK cohort (10-11/year) and 8 non-ASK residents (typically PGY4s) were compared with the same exam. Mean test scores were compared using paired and unpaired t-tests. Focus groups were transcribed and analyzed qualitatively for themes by two analysts. Results: In the pre-ASK focus group, residents looked forward to ASK; goals centered around growing from learner to expert (in research, teaching and medicine) and developing skills in critical appraisal. Local research contacts and expert advice were also expected. Post-ASK, residents were very satisfied with the rotation overall. The written exam (maximum score=36) showed significantly increased knowledge (time0 mean±SD=19.6±3.9; time1=29.9±3.2, p, Background/Purpose: Perceived lapses in professional behaviours are becoming increasingly common in residency programs. Research supports that skills in professionalism can be taught through role-modelling and structured curricula. To enhance professionalism in the Paediatric Residency Program at the Hospital for Sick Children, a novel curriculum was developed. The curriculum aims to cover content that is immediately relevant to residents, to facilitate recognition that expectations and practice culture may differ, and to incorporate evidence supporting professionalism training through reflection, mentorship, and small-group learning. Summary of the Innovation: The curriculum is comprised of five case-based sessions. Each session focuses on a different professionalism issue (requesting time off, use of technology and social media, interprofessional interactions, patient care, and boundaries). These themes were generated from real-life examples of professionalism issues that were anonymously submitted by residents and faculty and then framed by the professionalism objectives outlined by the American Board of Pediatrics. The curriculum aims to bring residents, fellows, and faculty together to discuss perceived lapses in professionalism in order to generate open discussion, a shared understanding, and approaches for promoting professional behaviours moving forward. Conclusion: Professionalism is an essential component of medicine and has been identified as a core competency in medical education. Our novel curriculum aims to enhance professionalism training by bringing staff and residents together to facilitate interactive, case-based professionalism discussions. The curriculum is generalizable across a variety of subspecialty programs and can be easily implemented. Participants endorsed open discussion involving staff and residents, cases that accurately reflected real life situations, and effective take-home points., Background/Purpose: Until recently, no formal undergraduate radiology curriculum has existed at McMaster University. We performed an audit of the radiology knowledge of the last graduating class who received no formal radiology teaching. This data will serve as a baseline to assess the longitudinal impact of the new curriculum we are developing. Methods: A 50-question multiple-choice quiz was administered to graduating medical students covering the topics of radiologic anatomy, imaging interpretation and appropriate imaging ordering. The validated questions were obtained through an international database provided by the Alliance of Medical Student Educators in Radiology (AMSER). The web-based platform used to create/administer the quiz (Radiology ExamWeb) provides detailed statistical analysis on each question; as such, the scores of McMaster students could be compared to international results. Results: A total of 172 (83.5%) McMaster students completed the quiz. The mean score for McMaster students was 64.5% vs. 72.8% (international average) (p=0.02). McMaster students had lower scores on radiologic anatomy (61.0% vs. 79.1%; p=0.01) and imaging interpretation (51.7% vs. 67.4%; p=0.04) sections. There was no difference between the groups on the questions involving appropriate imaging ordering (73.8% vs. 71.8%; p=0.71). Conclusion: This study noted deficiencies in the knowledge of McMaster graduates in the areas of radiologic anatomy and image interpretation. Our new curricular initiatives will focus on these areas with a goal to improve McMaster students' quiz results., Background/Purpose: In view of Canada's opioid crisis, we reviewed the undergraduate curriculum at our institution to determine if it reflects current attitudes, beliefs & knowledge in opioid prescribing & related topics. Methods: Learning events within the 'Pain' & 'Substance Abuse' integrated threads were extracted & analyzed from our learning management system. The content in each learning event was summarized & compared to medical competencies published by the Institut National De Santé Publique Du Québec (INSPQ) in non-cancer pain management & opioid prescribing. Results: Twenty-six learning events related to 'Pain' & 12 learning events related to 'Substance Abuse' were identified. The INSPQ describes 4 clusters of competencies: 1. Basic epidemiological, clinical & pharmacological knowledge relevant to non-cancer pain & opioids, 2. Evaluation of pain intensity & consequences of pain, 3. Evaluation of substance abuse & misuse, & 4. Management & follow up in patients using opioid therapy. Most (6/7) competencies within the first cluster were covered in the curriculum. Almost half (2/5) of competencies related to the second cluster were not explicitly covered, & 3/7 of competencies related to the third cluster were not covered. A third (3/9) of competencies within the fourth cluster were not explicitly covered. Conclusion: Our curriculum addresses competencies needed to manage non-cancer pain & prescribe opioids. This initial review identified potential gaps in other core competencies pertaining to opioids & related topics, such as substance abuse. Limitations to our review are that we could not analyze untagged learning events or new sessions. Next steps will include consultation with stakeholders to determine the extent of gaps in the curriculum and how they can be filled., Background/Purpose: While literature exists on student feedback to community service-learning (CSL), community organizations have played a small role in re-shaping CSL within medical curricula. This study aimed to analyze feedback from community supervisors involved in a CSL course at University of Toronto's Faculty of Medicine. Methods: Semi-structured interviews with supervisors (n=9) were conducted between October 2018 - January 2019. Interviews were transcribed and analyzed through thematic analysis. Results: Four overarching themes were identified. Perceived benefits to students by supervisors focused on their contributions to the development of future physicians through understanding community needs and exposure to organizations that may be resourceful to physicians. Secondly, organizational benefits of CSL were discussed including having extra hands to assist, work-specific benefits, and medical student's unique expertise. CSL benefits were not without challenges. Scheduling difficulties, motivating students to understand their work's value, and curriculum gaps identified were challenges supervisors faced. Three subthemes emerged under areas for improvement. Supervisors emphasized increasing flexibility to make experiences more meaningful. They also wanted more dialogue between organizations to gain insight from one another and a clearer understanding of CSL and its role in a curriculum. Conclusion: Community supervisors viewed academic institutions to be in a unique position having established many partnerships with community organizations. Developing networking opportunities between organizations should be encouraged across CSL programs in medical education. As well, clearer understanding of CSL as part of the medical curriculum was important for supervisors to better understand their roles and responsibilities., Background/Purpose: Within subspecialty residency programs there is a need to develop new training mechanisms for rare gray zone disorders (i.e. disorders where there is no consensus). Trainees must demonstrate competency in these areas but limited exposure and the absence of clear guidelines, makes learning increasingly difficult. The use of virtual patient cases is one approach to provide learners concrete experience for these rare disorders. Furthermore, when presented alongside expert testimonials or traces (described by Posel N. 2009), which delineate the spectrum of acceptable management choices, learners can develop sophisticated approaches to clinical ambiguity. This pilot study explores the use of VIRTUAL patient Cases with Expert Traces (Virtual CasET) for the teaching of rare gray zone disorders. Summary of the Innovation: Two virtual patient cases on rare gray zone thrombotic disorders were created through professional consensus using the VIC editor. Thrombosis experts (n=7) completed the cases and traces were generated based on their decisions (e.g. treatment choices). Hematology trainees (n=12) subsequently completed the cases and were shown the expert traces. Learners contrasted their approach with the expert traces and participated in a guided case debrief. Learners completed a questionnaire which included pre/post ratings of clinical confidence. Qualitative thematic analysis of the debrief was performed using phenomenological inquiry. Conclusion: Virtual CasET is a promising approach to rare gray zone conditions. Learners positively rated their experience and noted improved confidence in handling uncertainty. Learners were able to identify and integrate core principles from the traces. Unexpectantly, learners endorsed an enhanced appreciation for collaboration with colleagues when faced with gray zone cases., Background/Purpose: The Clinical Teaching Unit (CTU) has emerged as a ubiquitous model of clinical education across medical schools, since its inception over 50 years ago. However, health care has changed dramatically over this period, and we thus reviewed existing evidence on principles of CTU design that optimize clinical education and health service delivery in the 21st century. Methods: We performed a systematic review in accordance with the Cochrane Review protocol. Databases, including MEDLINE, Embase, and Cochrane Database of Systematic Reviews, and CINAHL, were searched to find primary research articles published from 1993 to 2019 which discussed trainee education and/or health care delivery in the context of a clinical teaching unit or other teaching ward. Results: Studies meeting inclusion criteria after full-text review were analyzed according to the Star Model viewing health systems as a collection of interdependent subsystems including: strategy, structure, human resources, incentives, and information and decision support. We added a sixth subsystem for education given its core relevance to CTUs. Most existing evidence focuses on the structure and education subsystems, including approaches to ward rounds, optimal call structures, and novel educational strategies. However, many articles involved low to moderate quality evidence. Conclusion: Efforts should be made to generate higher-quality evidence on the design of clinical teaching units as a dual model for both clinical education and health service delivery. Further knowledge translation efforts may be necessary to ensure that known best practices in CTU design become common practice., Background/Purpose: Medical education is a fundamental principle of an academic healthcare institution. However, compared to research and patient care roles, clinician teachers have historically felt undervalued and underappreciated. Research has shown that clinician teachers are intrinsically motivated for their work, but there is a lack of institutional recognition for their contributions to medical education (A. Freeland, 2019). In our large community hospital with an academic mandate, we propose to recognize and reward the efforts of clinician teachers using a mobile application based on gamification principles. Summary of the Innovation: We developed a mobile application named TutorTracker using the cross platform (i.e. Android, iOS, Windows etc.) and open-source development software Ionic. Teaching data is extracted from the education office spreadsheets and downloaded to the application. Using a password protected application, physicians can track their clinical teaching using various parameters such as hours of online teaching, date, subject and course. The application then rewards users, using virtual badges, for quantity and diversity of teaching. The application also provides a summary of the users clinical teaching history for ease of submitting yearly hospital and university renewals as well as for documenting yearly continuing medical education (CME). Conclusion: Gamification principles have been effectively implemented to construct a mobile application allowing clinician teachers to track and be rewarded for their educational responsibilities. Next steps would be to evaluate the application utilization and satisfaction, assess change in physician teaching and to iterate improvements in the application., Background/Purpose: Arthritis, diabetes, back pain and headache are common reasons for medical visits. These presentations require a combination of neurological and musculoskeletal physical examinations, highlighting the importance of proficiency in them. However, it is unclear how comfortable medical students are with these examinations as they enter clerkship. The aim of this study is to examine pre-clerkship medical students' comfort level with performing and interpreting the neurological and musculoskeletal examinations. Methods: This cross-sectional study surveyed pre-clerkship medical students at Queen's University School of Medicine. Students completed a web-based electronic survey with questions about demographics, studying resources, practice patterns, comfort with neurological and musculoskeletal examinations, and curricular feedback. Data analysis was performed using Microsoft Excel and IBM SPSS. Results: 90 students (48.9% Year 1, 51.1% Year 2) participated in this study. 15.6% of students were uncomfortable with both the neurological and musculoskeletal examinations. Within the neurological exam, students were least comfortable with cognitive testing (63.3%) and sensory examination (14.4%). Within the musculoskeletal exam, students were least comfortable with wrist (75.5%) and elbow (70.0%) exams. Students provides 24 unique feedback suggestions for improvement in the clinical skills curriculum. Conclusion: This study highlighted specific components of the neurological and musculoskeletal examinations that pre-clerkship medical students were least comfortable performing. Feedback from this survey will be used to improve the clinical skills curriculum and course manual, including opportunities for more frequent supervised practice and periodic review., Background/Purpose: An identifiable area for improvement in Canadian medical school curriculum is the decline in safe learning opportunities for students to perform clinical skills. As a result, anxiety around performing clinical procedures is increasing, while confidence and self-perceived knowledge of clinical skills is decreasing. Providing low-risk learning opportunities for pre-clerkship medical students to practice essential clinical skills would help to address this learning gap. Summary of the Innovation: A program modelled on a pilot study by Battaglia et al. was implemented at the University of Alberta. Six second year students were selected as peer teachers and trained in how to teach four high-yield clinical skills by residents. These students then taught 18 second year medical students using a near-peer teaching model to reduce anxiety and expectations regarding performance. Self-perceived knowledge and mental status were examined before and after the four sessions. There was a significant (⍺ = 0.05; p = 0.0008) difference in mean state anxiety scores pre and post program using a State-Trait Anxiety Inventory. All four sessions resulted in significant increase in self-perceived knowledge, including suturing, airway management, IV starts, and local anaesthetic (⍺ = 0.05; p = 0.0007, 0.0000, 0.0001. 0.0001, respectively). Conclusion: Implementing a near-peer pre-clerkship clinical skills program resulted in a decrease in situational anxiety and an increase self-perceived knowledge of clinical skills. This study contributed toward the integration of clinical skills for pre-clerkship students at the University of Alberta, but further studies are recommended to continue to develop clinical curriculum., Background/Purpose: The nature of clinical practice is ever-changing, varies according to the attributes of those enacting it, and poses complex questions that must be considered within context. As such, healthcare professionals need the ability to understand and respond to the larger contexts of the healthcare system. Existing approaches to describing clinical practice may be limited in how they conceptualize such context and complexity. Methods: We sought to evaluate how conceptualization of paramedic practice may be optimized using a systems approach. We examine the role of combining an adaptation of Ecological Systems Theory (EST) and complexity thinking as ways of describing paramedic practice. Results: EST can be adapted to outline the elements of clinical practice. This obligates a focus on various healthcare system levels which are often missing from our descriptions of practice. Complexity thinking obligates a focus on the non-linear, unpredictable nature of relationships between these elements. When combined, these frameworks allow for identification of elements within the system that may have value in describing clinical practice. We illustrate how aspects of paramedic practice may be ignored until viewed from a merging of these approaches. Conclusion: Merging EST with complexity thinking provides an opportunity to reflect the complex realities of clinical practice when attempting to describe it. This conceptual framework promotes a focus on factors from macro level to individual patient level, as well as on the relationships within the system. This can be used as a foundation to inform future efforts to represent clinical practice, such as in the development of competency frameworks., Background/Purpose: Continuing professional development (CPD) is an essential component of nurses' practice, especially in Emergency Departments, which are characterized by constantly evolving practices and technologies. Nevertheless, there are no current CPD programs in Emergency care for Canadian nurses. The purpose of the project was to develop a forward-thinking program that would encompass the Emergency Nurses' core competencies using evolving research-based on adult learning principles. Summary of the Innovation: A team composed of nurses from Québec and British Columbia have led the development of a bilingual education program with the collaboration of clinical experts across Canada. Peer review ensured the quality of the content and translation in both languages (English and French). Emergency Practice, Interventions and Care - Canada (EPICC) program includes four courses lasting one or two days: 1) emergency care, 2) trauma care, 3) pediatric care and 4) educator. All courses are based on active learning and promote feedback to drive learning. The EPICC program focuses on 1) the ability to assess a situation, 2) interpret it, 3) communicate, and 4) react and seek help as needed. Conclusion: Since 2016, 3525 learners have participated in one or more EPICC courses across Canada. EPICC uses innovative ways to promote education for emergency nurses. Challenges include standardization of teaching and implementation in rural areas. Data collected shows a high level of satisfaction from participants. Future research is planned to measure the impact of the program such as the improvement of team communication., Background/Purpose: Quality Improvement (QI) science is quickly becoming an effective and acceptable approach for teaching physicians how to inspire and lead positive change in healthcare. Currently, across Canada there is minimal experiential education for undergraduate medical students regarding QI. Students learn little about how they can change the systems that they will work in and are missing out on exposure to the leadership potential of their roles. In a response to this opportunity, the Department of Medicine, Alberta Health Services and Undergraduate Medical Education office developed the Summer Healthcare Improvement Program. Summary of the Innovation: To provide students with hands-on QI experience, a 15-week program was launched in 2017. Since then, 19 students have completed 22 projects. Students work closely with a Sr. Quality Consultant and a MD to gain on-the-ground experience running projects. Additionally, students received optional QI readings, and opportunities to attend quality council meetings and regional QI days. All students also received Evidence-based Practice in Quality (EPIQ) certification. To assess the effectiveness of the SHIP program, a pre and post-survey was implemented along with a SWOT analysis. Conclusion: 90% of students who responded to the surveys thought their peers could benefit from participating in SHIP and 71% of the respondents thought their SHIP experiences would be useful in future practice. Difficulties included gaining funding, coordinating with student schedules and ensuring students saw all parts of the QI process. Overall, students expressed a desire to learn more about QI and were engaged when given the opportunity to learn more. It was felt that SHIP demonstrated the need for and benefit of QI education earlier in medicine., Background/Purpose: Quality improvement is critical in improving institutions' practices, priorities and performances. In undergraduate medical education (UGME) programs an accreditation requirement, and one of the key quality improvement initiatives, is the review of curricular and assessment. However, there are multiple types of courses with varying objectives, structures, and modes of delivery. This variability introduces numerous challenges to identify a single evaluation approach, particularly in assessment. Whilst some assessment frameworks exist in medical education, they • prioritize only one essential aspect (e.g., validity), but neglect others • lack for flexibility of evaluating different types of assessments • focus on outcomes but neglect the process of evaluation Summary of the Innovation: • A unified framework is developed to evaluate assessment use and interpretation of outcomes that is applicable across all of UGME courses. This framework is theory-based, research-supported, and practice-oriented. It not only addresses the key criteria of assessment, but also fosters a culture of continuous improvement by aligning with CACMS Accreditation Standards; • Multiple data sources generated from this framework taking into account all relevant stakeholders paint a rich, multifaceted picture of the assessments; • The implementation of this framework at both classroom and clinical-based courses effectively identifies the strengths and challenges. It contributes to professional development by raising awareness and broadening skills for designing assessments for educators. Conclusion: This innovative framework of assessments evaluation not only integrates key features and accreditation standards of assessment, but also serves as a unified methodological guide of course review in any institution to achieve the quality improvement goals., Background/Purpose: Speakers play a key role in making Continuing Medical Education (CME) programs effective for participants. While evidence has identified distinctive characteristics of an effective lecture, to the best of our knowledge, there is no clear definition of “speaker effectiveness” in CME. Objective: To compile existing evidence related to speaker effectiveness in CME programs. Methods: Systematic review of the literature studying CME participants' perspectives of speaker effectiveness, filtered by full-text and the English language. Results: Seventeen articles met the inclusion criteria and were selected for full text review. Results suggested that speakers who incorporated ARS/active learning/interactive learning, case studies/clinical cases and specific (rather than broad) program content, were generally deemed to be more effective. With respect to presentation layout/articulation, speakers who utilized workshops, kept presentations shorter in duration and spoke coherently, were also considered to be more effective. Mixed results were seen regarding speakers' academic rank/credentials and the impact this has on speaker effectiveness. Perceptions of speaker effectiveness were also audience-specific, varying on age, stage in education and specialty. Conclusion: While the literature provides some characteristics of “speaker effectiveness”, further studies are needed to clarify this concept in the context of CME. Results of this study might guide speakers committed to improve the effectiveness of their future CME presentations., Background/Purpose: Rural clinical exposure plays a vital role in recruiting and retaining physicians to rural areas, while structured mentorship programs support student development. We describe the structure and evaluation of a new Rural Mentorship Program (RMP), which provides pre-clinical medical students at our large urban medical school with rural exposure through mentorship. We aim to identify benefits and challenges of the RMP, assess how mentorship from rural physicians influences medical student perceptions and intentions towards rural careers, and identify possible facilitators of success. Summary of the Innovation: The RMP paired 1st and 2nd year medical students with physician mentors in four rural communities. In response to a relative deficit in rural exposure at our institution, this student-developed program was delivered as a 3-month pilot. During the program, mentees communicated with mentors remotely and visited their mentor's community for at least one clinical experience. Mentor and mentee questionnaires assessed program satisfaction and attainment of objectives. Mentees rated their perceptions and intentions for rural careers pre- and post- participation. Focus groups and interviews were used to deepen insights. Though there was no statistically significant impact on career intentions, participants reported overall satisfaction. The early rural clinical exposure was believed to be the most valuable component. Mentees appreciated the authentic relationship with their mentors, and mentors valued the enriching teaching opportunity. Conclusion: Our results will contribute to literature supporting the role of urban medical schools in advancing rural medical education and promoting recruitment of rural physicians. Further program implementation is required to observe possible long-term impact., Background/Purpose: While women account for more than half of graduating medical students, women physicians are outnumbered in leadership roles, more likely to experience mistreatment or harassment, and report higher burnout rates. In an effort to mitigate gender bias in medicine and promote well-being in women medical trainees, a Women in Medicine student club was established to create a safe space to discuss unique issues that affect women in medicine, share resources and provide support. Summary of the Innovation: Events held by the club included informal discussion groups, several lunchtime talks, and a week of events surrounding International Women's Day. The club worked together to provide recommendations to change student mistreatment policies. An active Facebook group where club members post news and event links contributed to the development of a sense of community. The inaugural year of the club culminated in a mentorship event which brought together female physicians and medical students in a speed networking format. Anonymous qualitative feedback was solicited at the end of the event. Conclusion: The mentorship event was met with excellent feedback from both physicians and students. Physicians enjoyed meeting students and providing career advice. Some physicians reflected that they wished there was a similar initiative in place when they were in medical school. Students appreciated insights from a variety of medical specialties, especially as it pertains to career exploration. Students and physicians alike praised the relaxed nature of the mentorship event held at a local coffee shop without the demand of clinical duties. Next steps for this new club include continuing the mentorship event in upcoming years as well as continuing to develop community and support among women medical students., Background/Purpose: There is a marked increase in clinical responsibilities on call for pediatric residents during Transition to Discipline. Following a survey of the outgoing pediatric PGY1 residents, we identified a need to provide a more structured and experiential orientation for the incoming PGY1 residents prior to their first night on call. We created a “shadow call” to orient the incoming PGY1 residents, increase their level of comfort on call, and optimize patient safety. Summary of the Innovation: In July 2019, pediatric PGY1 residents were paired with PGY2 residents for a “shadow call”. Objectives, structured checklist, observation notes and discussion prompts were developed through a needs assessment survey of the outgoing PGY1 residents. The PGY1 residents followed a PGY2 resident during handover, an admission, assessment of ward patients and documentation. Discussions were encouraged. Participant satisfaction was evaluated by a voluntary online survey. Conclusion: Twelve out of twelve incoming PGY1 resident participants felt that the shadow call was a valuable component of the orientation, and identified one-on-one discussion with a PGY2 resident to be the most useful aspect. They reported an understanding of the expectations on call, comfort with their first night on call, and confidence in their ability to care for patients safely. All five PGY2 residents reported that having a shadow buddy did not add to their workload on call, and noted the benefit of building a meaningful relationship with the PGY1 residents. While the shadow call was designed to be observational, some PGY1 residents identified areas where greater participation under direct supervision of a senior resident would have further enhanced the experience., Background/Purpose: Many physicians lack confidence in their knowledge of nutrition stemming from inadequate instruction in training. At Queen's medical school, nutrition is assigned to the first year Pediatrics course, tied to childhood growth and development. Recognizing its position early in the curriculum provides a unique opportunity, we asked: Can nutrition concepts be constructed and delivered in first year medical school in a way that allows for retained knowledge and confidence in clerkship? Summary of the Innovation: A backward design model was applied to create a cohesive nutrition unit. A survey was developed to provide evidence as to the efficacy of the program, capturing knowledge and comfort with the material. Varied learning events with a clear progression of complexity were designed. The survey was administered to the students both before and after the unit and compared to their peers in clerkship. The survey was then re-administered to the students who participated in the unit in clerkship to address retention of knowledge and confidence. There was no difference between the first-year students and clerks prior to implementation. However, first-year students performed significantly higher and felt more confident after the unit (p, Background/Purpose: Postgraduate medical training at Addis Ababa University (AAU) has been enhanced through support from the University of Toronto (U of T) through the Toronto Addis Ababa Academic Collaboration (TAAAC). There is present need for improved training to address childhood blindness in Ethiopia. Our aim was to assess the feasibility of implementing a pediatric ophthalmology fellowship at AAU, supported by U of T, modeled on the TAAAC. Methods: A situational analysis was conducted at Menelik II, the teaching hospital providing ophthalmology services in Addis Ababa. Staff expertise and clinical, patient, and educational resources were reviewed and compared to International Council of Ophthalmology fellowship guidelines. Local training needs were evaluated. A strategic working meeting facilitated program specification. Results: A two-year fellowship incorporating research, faculty feedback, case log review, and formal examination as quality indicators was proposed. Anterior segment, retinoblastoma, strabismus, and retinopathy of prematurity were identified as priority areas requiring support. Learning outcomes were deemed feasible given the high volume of complex cases, qualified staff supervision, and sufficient equipment. Telemedicine, development of a larger eye hospital, and partnerships to support equipment acquisition and maintenance were identified as strategies to manage barriers. Conclusion: The on-site needs assessment demonstrated feasibility in implementing a pediatric ophthalmology fellowship, the first of its kind in Eastern Africa, and provided a way forward for its development. However, strategic partnerships may be crucial to ensure resource sustainability. Academic partnership between Canada and Ethiopia is an exciting avenue for initiatives to strengthen cultural competencies in both nations., Background/Purpose: Postgraduate medical training at Addis Ababa University (AAU) has been enhanced through support from the University of Toronto and the Toronto Addis Ababa Academic Collaboration (TAAAC). There was a clear need for improved training to address the high burden of visual impairments among children in Ethiopia. A situational analysis conducted at Menelik II, AAU's teaching hospital, demonstrated feasibility in implementing a pediatric ophthalmology fellowship, the first in Eastern Africa. Our aim was to develop curriculum following International Council of Ophthalmology's guidelines, modelled on the TAAAC. Summary of the Innovation: A two-year fellowship incorporating research, faculty feedback, and formal examination as quality indicators was proposed. Anterior segment, retinoblastoma, strabismus, and retinopathy of prematurity were identified as priority areas requiring support. Modules were designed to have in-person training by SickKids Ophthalmologists, supplemented by online e-tutorials. A secure platform for online content was created to house module content, journal libraries, and equipment tutorials. A strong tele-education link between Menelik II and SickKids was developed. Additionally, pediatric-specific ophthalmology equipment was purchased. Conclusion: Tele-education through successful transmission of lectures for fellows at SickKids to Ethiopia allowed real-time teaching. Lecture recordings were then put online for review as additional resources. The online component allowed trainees to personalize learning needs. Longevity in practice is supported by the online format, in-person training to build capacity, and provision of equipment difficult to source locally, with education in its care and maintenance. Continuous feedback from all stakeholders was incorporated throughout program development., Background/Purpose: Given the numerous developmental milestones tracking the growth of infants and children, it is a daunting task for learners new to the topic. We designed a new multimedia resource to supplement this learning for 2nd year medical students within the clinical skills curriculum. Summary of the Innovation: The framework for the content was designed using key components of cognitive learning theory and principles of multimedia instruction. Based on the dual channel theory, it was decided to create multimedia content, optimizing both visual and verbal information processing. Given the extensive details within this topic and knowledge of cognitive load, attention was drawn to an appropriate level of detail while avoiding redundancy. We minimized extraneous processing by utilizing basic black and white drawings with accompanying text and key headings to highlight content. To manage essential processing, learners were encouraged to review a corresponding resource to optimize the learning before and during engagement with the video. We strived to foster generative cognitive processing using a recorded conversational style narrative. The multimedia content itself was created with VideoScribe (Sparkol, Bristol UK) using hand drawn illustrations that highlighted the slight nuances in child development. Conclusion: This resource was developed in a 4 week research block by a 4th year medical student in order to integrate educational theory and curriculum delivery. It was well received by reviewers, faculty and students and has become part of our core curricular content at UBC. We believe the novelty and feasibility of this innovation highlights the capacity we have to develop resources for learners., Background/Purpose: The benefits of breastfeeding for both the mother and baby are well known. In North America, the proportion of female trainees and physicians in practice is rising. Medical students and residents train during the peak of their reproductive years, but breastfeeding rates tend to be lower in female medical professionals compared to the general population. The purpose of this study was to explore barriers to breastfeeding among female trainees and physicians. Methods: We conducted a scoping review using Medline and Embase. Abstracts were considered for further review if they included information on breastfeeding in physician and medical student mothers. After the initial screen reference lists of included studies were reviewed for further study identification. Two independent reviewers read and extracted demographic information, barriers, and breastfeeding rates from included studies. Results: A total of 2128 abstracts were screened and 55 studies fully reviewed. The most commonly identified barriers to maintaining breastfeeding were short length of maternity leave, heavy workplace demands without established breaks, perceived or actual lack of colleague support, and lack of appropriate pumping location or equipment. Women in hospitals that included dedicated pumping spaces with computer, telephone, and refrigerator access reported longer duration and better quality of continued breastfeeding experience. Conclusion: Female trainees and physicians have many barriers to maintaining breastfeeding upon return to work. Departmental policies that include established breaks and conveniently located pumping locations with electronic medical record access and telephone might improve rates and achievement of breastfeeding goals., Background/Purpose: Although a required skill in pediatric residency programs, success rate of neonatal endotracheal intubation (NETI) among trainees is low. NETI is taught using simulation with limited short-term retention of skill. In the clinical setting, NETI is associated with stress, which effect on success is poorly studied. The objective is to assess the impact of stress on the success of simulated NETI. Methods: Crossover randomized controlled trial. Pediatric residents randomized to perform NETI in low (LS) or high stress (HS) environment, and then crossover. Stress was created using audio alarms, third party supervisors and simulated manikin instability. Stress of participants was assessed at rest, before and after each scenario. Stress assessment included: salivary cortisol, heart rate and the State Anxiety Inventory (STAI) questionnaire. Primary and secondary outcomes include: success rate, time to successful intubation and stress levels. Success rate was analyzed using chi2 and continuous variables were analyzed using paired t-test and repeated measures ANOVA. Results: 49 residents (97 NETI) have been recruited and have completed the study. Success rate in the HS group was 60% vs 51% in LS (p=0.41). There was no significant difference with regards to duration of NETI, duration of scenario or salivary cortisol. Heart rate was significantly different between HS and LS groups (p, Background/Purpose: Despite data supporting its staggering importance in health outcomes, medical curricula has not traditionally focused on social determinants of health (SDH). Commonly, curricula have positioned SDH as a list of risk factors to memorize rather than focusing on the upstream, broad societal factors that perpetuate disparity. Children are particularly vulnerable as adverse childhood experiences (ACEs) alter lifelong health trajectories. A 2019 scoping review reported the need for formal programming addressing SDH. Subsequently an expert consensus panel has put forward a call to action. Summary of the Innovation: The objective was to create and implement a deliberate Social Paediatric curriculum prompting students to evaluate their own beliefs and bias, and equipping students with skills to identify actionable change. A review of the current undergraduate curriculum revealed a paucity of dedicated opportunity for addressing SDH in Paediatrics. This was particularly clear to see within the clerkship program, where concepts were integrated but not emphasized. Using consensus panel recommendations a longitudinal program extending from pre-clinical to clerkship years was developed. The curriculum involves: 1) interactive introductory online learning modules; 2) didactic teaching session in clerkship; 3) written reflection on a clinical case; 4) small group, inter-disciplinary case-based learning; 5) practice OSCE station. Results: With early childhood development being particularly susceptible to the impact of SDH and health inequity, Paediatricians and Paediatric training has an obligation to rethink what is taught and how we can shift from knowledge and lists to action and integration. Next steps will include evaluation and revision of the program., Background/Purpose: Until 2019, PGY-1 psychiatry residents at McMaster University participated in academic learning sessions that were held with numerous other specialties, leaving psychiatry residents feeling that these sessions lacked applicability to their own learning. Due to changes at the postgraduate level, our program developed an independent PGY-1 medical psychiatry curriculum to address resident needs and improve the learning gap between psychiatry and medicine. Summary of the Innovation: A scoping assessment was completed by collating focus group feedback and rotation assessments from the previous curriculum. This data grounded the planning and development of a case-based PGY-1 psychiatry curriculum with a medical focus. This innovation relies on a group of interdisciplinary educators from Psychiatry, Emergency Medicine, Neurology and Internal Medicine who actively participated in curriculum development. 15 case-based sessions, including simulation sessions, were created focusing on core topics including cardiac emergencies, seizures, neurological issues, and chronic health issues, situated within psychiatric settings. Significant depth of medical information is provided including labs and images, enhancing learning across both medical and psychiatric objectives. Triple-jump style cases allow for learning and application of knowledge within sessions and aim to improve knowledge retention and application. Each session concludes with formal learning reflections, designed to consolidate knowledge and promote lifelong learning. Conclusion: This session will discuss the cross-disciplinary collaborative process involved in curriculum development, provide examples of cases developed, and discuss how attendees can use this method to develop robust, cross-disciplinary curricula relevant to learners within their own settings., Background/Purpose: New guidelines from the Accreditation Council for Graduate Medical Education (ACGME) have proposed minimum case volumes to be obtained during residency but there are currently no minimum case volumes standards for radiology residency training in Canada. Using data from a pilot study, we examine radiology resident case volumes among recently graduated cohorts of residents and determines if there is a link between case volumes and measures of resident success. Methods: Resident case volumes for three cohorts of graduated residents (2016-2018) were extracted from the institutional database. Achievement of minimum case volumes based on the ACGME guidelines was performed for each resident. Pearson correlation analysis (n = 9) was performed to examine the relationships between resident case volumes and markers of resident success including residents' relative knowledge ranking and their American College of Radiology (ACR) in-training exam scores. Results: A statistically significant, positive and strong correlation was observed between residents' case volume and their relative knowledge ranking (r = 0.682, p < 0.05). Residents' relative knowledge ranking was also strongly and positively correlated with their ACR in-training percentile score (r = 0.715, p < 0.05). Conclusion: This study suggests that residents who interpret more cases are more likely to demonstrate higher knowledge. This highlights the utility of case volumes as a prognostic marker of resident success. The results also underscore the potential use of ACGME minimum case volumes as a prognostic marker. These findings can inform future curriculum planning and development in radiology residency training programs., Background/Purpose: The learning environment is recognized as a key aspect of effective postgraduate medical education programs. Less is known regarding how resident perceptions of the learning environment vary across program disciplines. This study sought to explore current strengths and challenges of the learning environment at a Canadian medical school, and compare and contrast how they vary across programs. Methods: A survey was distributed to all residents at our institution for two consecutive years, with open-ended questions to elicit strengths and challenges of the learning environment. Survey data was coded using NVivo, and analysis proceeded using a grounded theory approach. Results: 504 residents participated (58% response rate). Three themes emerged from analysis, each manifesting as a strength and challenge of the learning environment: interpersonal relationships, program structure and organization, and learning opportunities. Across all programs, residents described approachable attending physicians as a strength of the learning environment. Call structure, including frequency and lack of post-call days, particularly among surgical residents, negatively impacted work-life balance; however, similar challenges were expressed by residents in other disciplines in the absence of frequent call. Internal medicine and surgical residents felt that clinical service demands and “scut work” hindered learning opportunities to a greater extent than family medicine residents. Conclusion: Dichotomies in how the three themes of interpersonal relationships, program structure and organization, and learning opportunities manifest as a strength or challenge of the learning environment demonstrate many similarities and subtle differences among programs, providing opportunities for institution-wide and program-targeted interventions to improve the learning environment., Background/Purpose: Medical students must match and complete a residency before becoming licensed physicians in Canada. Matching is facilitated by rank-order lists submitted concurrently by students and residency programs. Lessons from the Monty Hall problem suggest a possible improvement to the match. We proposed the Monty Hall adjustment to the existing match, with one key difference: student's rank order lists are edited by removing programs that did not rank them prior to running the CaRMS algorithm. Methods: A Monte Carlo simulation was created to investigate the difference in match rate between the two models. Rank order lists (ROL) for students and programs were generated from distributions emulating known populations. The matchingMarkets package from R facilitated the match. Five factors were varied with 100 replications to systematically identify the best scenarios between the two models: standard deviation of student file review scores, number of residency positions per student, number of students interviewed per position, percentage of interviewed students that were ranked, and number of direct entry programs. Results: Initial results suggest an average of 1.7% match rate gain using the Monty Hall adjustment across scenarios. Moreover, increasing the number of interviews per student to a ratio of 1.2 or decreasing the number of CaRMS entry programs yielded significant gains. Conclusion: From the statistical simulation, we recommend further investigation of the Monty Hall model with pre-collected CaRMS data, increasing the number of interviews per residency spot, increasing the ratio of residency positions to students to 1.2, and combining suitable programs into fewer common entry programs., Background/Purpose: Human trafficking (HT) is prevalent in Canada and victims are predisposed to numerous health concerns. Many encounter healthcare practitioners during captivity, but the level of awareness and knowledge among front line physicians is low. Limited data exists on attempts to address this within residency training programs. Formal curriculum time in residency is limited, so online modules may be a useful alternate modality. Methods: Family medicine, emergency medicine and general pediatrics residents at the University of Alberta were invited to participate. They completed short surveys including knowledge assessment questions before and after completing an online learning module on HT. Baseline and post-intervention changes in both self-reported and tested knowledge were assessed. Results: 32 residents completed the pre-survey: 6% self-identified as somewhat knowledgeable on HT and 16% knew red flags to identify victims. 81% wanted this topic incorporated into residency training, but only 6% had previous education in residency, and 25% in medical school. 13% were comfortable reporting victims, and 6% reported knowing how to report. 20 residents completed the post-survey, with improvements in both self-reported (p, Background/Purpose: Systemic racism has been noted to be pervasive in our society and found to be a social determinant of health for patients. Racism experienced by healthcare staff impacts wellbeing of patients and healthcare providers. The objective of this study was to estimate the prevalence of witnessed or experienced racial discrimination among post-graduate medical trainees and their response to these encounters at one large academic health centre. Methods: Post-graduate Medical trainees (n=840) at the University of Calgary were surveyed using a ten-question questionnaire. The survey was distributed by the Post-graduate Medical Education office. Participation in the study was entirely voluntary and all data was collected anonymously. Data was collected through the online survey Platform REDCap. This study was approved by the research ethics board at the University of Calgary. Results: The response rate for this survey was 12%. 52% (n=52) of responders indicated they had witnessed “everyday” or overt racism during their post-graduate medical training. Witnessed microaggressions (n=34) were most commonly reported by trainees followed by experienced microaggression (n=17), witnessed overt racism (n=16), and experienced overt racism (n=7). Most respondents (n=38 witnessed and n=15 experienced) did not take action in response. Conclusion: Our study shows that systemic racism is common and prevalent in post-graduate medical training in Canadian healthcare. This is directed towards patients, trainees and other members of the healthcare team and constitutes “everyday racism” most frequently, consistent with studies in the United States. Trainees frequently did not take action in these situations given the hierarchical nature of medicine and fear of repercussions., Background/Purpose: Resident physicians are often on the front lines of patient care and are likely to witness adverse events first hand. The goal of this narrative review was to examine the current literature with respect to strategies to increase patient safety event reporting by residents. Methods: We used CINAHL, EMBASE, PsycINFO, and PubMED. The search was limited to English-language articles published in peer-reviewed journals through April 2018. Participants included “residents, trainees, fellows” and key terms used to identify interventions were: “event reporting, patient safety reporting, incident reporting, adverse event, medical error”. To guide study appraisal and synthesis, we adapted Peter's Five Strategies for Encouraging Self-Protective Behavior framework. Results: We identified 59 articles that described strategies used to increase event reporting. The most common strategy, surveys and interviews, were instrumental in assessing current barriers to reporting and/or the trainees' understanding of patient safety and for increasing awareness of event reporting. Behavior modeling and training was also essential for educational purposes, addressing deficits in knowledge and/or specific hospital systems used for event reporting. Lastly, frequent messaging was needed to reinforce behaviors that are often not part of routine patient care. One limitation of our review was that we did not find interventions which occurred after the submission of a safety event. Conclusion: The ideal, most successful sustainable interventions will be those that combine strategies that minimize time for busy physicians, incorporate constant reminders in already existing medical records, and become part of normal workflow in patient care., Background/Purpose: Les précepteurs jouent un rôle déterminant dans l'apprentissage et développement des compétences essentielles pour être un médecin qualifié. Dans ce contexte, la rétroaction formative constitue un élément clé dans le développement des compétences cliniques chez un futur médecin. On se demande donc ce qu'est une rétroaction efficace. Ce projet visait à identifier les principales variables susceptibles d'influencer la rétroaction. Methods: Nous avons effectué une recension systématique des écrits en anglais et en français à travers des bases de données scientifiques suivantes: ERIC, CINHAL, PsyInfo, PubMed, Ovid, ainsi que dans la littérature grise. L'ensemble des articles sélectionnés a permis de classer les informations en dix (10) catégories. Results: Sur les 340 articles identifiés, seuls 104 articles ont été retenus pour l'analyse. Les variables qui semblent le plus affecter la rétroaction sont: le milieu de formation, les objectifs de la rétroaction, le type de rétroaction, le niveau de formation des précepteurs, la fréquence de la rétroaction, le contexte de pratique, la nature des outils, l'utilisation de la technologie, l'étudiant, les outils utilisés. Conclusion: Nos analyses révèlent 10 variables qui sont les plus importantes dans l'efficacité de la rétroaction., Background/Purpose: Practicing empathy is an imperative in the practice of humanistic medicine. However, the central role of empathy has been thrown into question in part due its associations with physician burnout and compassion fatigue. This scoping review aims to provide a clear framework to consolidate and understand the effects of empathy on a physician's individual personhood, as understood through Krishna et al.'s Ring Theory of Personhood. Methods: A search of 7 databases (Pubmed, Cochrane, ERIC, Embase, PsycINFO, CINHAL and Google Scholar) was conducted till 17 November 2018. Papers were screened using a set of inclusion and exclusion criteria, and corresponding data was extracted and analyzed. Results: 7663 titles and abstracts were retrieved, of which 108 articles were analysed. Our research revealed that when a physician practices empathy, it impacts 3 broad aspects of his individual personhood. Firstly, it changes his personality, values, ethics and morals. Secondly, it impacts his clinical competency (in terms of clinical acumen and time management) and reputation. Lastly, it affects his physical and emotional well-being, with implications for burnout, compassion fatigue and compassion satisfaction. These results demonstrate that practicing empathy has significant impact on a physician's individual personhood, providing evidence that empathy should be encouraged and nurtured in medical education as it facilitates the acquisition of values imperative to a physician's personal growth and clinical practice. Conclusion: The practice of empathy should be regarded as a key competency to be attained in medical education as it has significant effects on a physician's individual personhood and eventual medical practice., Background/Purpose: While empathy is clearly essential to the humanistic practice of medicine, it is less intuitive how empathy influences a physician's relational and societal personhood. Our scoping review explores how practicing empathy interacts with and affects elements in a physician's relational and societal world by utilising concepts of Krishna et al.'s Ring Theory of Personhood. Methods: 7 databases (Pubmed, Cochrane, ERIC, Embase, PsycINFO, CINHAL, Google Scholar) were searched till 17 Nov 2018. Papers were screened using the determined inclusion and exclusion criteria. The corresponding data was extracted and analyzed using a coding framework. Results: 7663 titles and abstracts were retrieved, of which 108 articles were analysed. Thematic analysis revealed that practicing empathy had implications on 6 aspects of a physician's relational and societal world: 1) relationship with family, 2) relationship with colleagues, 3) teaching role, 4) physician-patient relationship, 5) professional obligations and 6) guardian of societal resources. Our results demonstrate that practicing empathy has significant impact on a physician's interactions with the world around him, providing evidence for the notion that empathy should promoted in medical education as it is a key driver and foundation of humanistic care and effective relationships. Conclusion: Practicing empathy impacts a physician's relational and societal personhood. Medical education should prioritise nurturing empathy as a key competency, as it has significant effects on a physician's relational and societal personhood and can drive humanistic goals of healthcare., Background/Purpose: L'enseignement de la communication et des enjeux éthiques dispensé aux étudiants reste un défi en éducation médicale. Depuis 2014, les étudiants de l'Université de Montréal produisent, dans le cadre d'atelier d'éthique clinique, des vignettes portant sur des situations humaines complexes vécues pendant leur externat. Plus de 1500 vignettes écrites par les étudiants, ainsi qu'une trentaine de vignettes écrites par les patients partenaires coformateurs ont été le tremplin vers une initiative pédagogique, sur une base pleinement volontaire. Summary of the Innovation: Certaines vignettes marquantes ont retenu l'attention des coanimateurs et suscité intérêt et discussions. Les membres de la Direction collaboration et partenariat patient (DCPP), le Bureau de l'éthique clinique (BEC) de la faculté de médecine de l'Université de Montréal ainsi que des comédiens se sont réunis pour coconstruire avec les étudiants et les patients une soirée théatre de mise en lecture de ces vignettes. L'importance des thèmes, l'impact émotif du contenu et la puissance pédagogique portés par ces vignettes ont mené l'équipe à vouloir mettre en lumière les éléments éthiques. Cette soirée a été présentée dans le cadre d'un colloque en pédagogie médicale (SIFEM) en mai 2019 à Montréal. Conclusions: Fermement ancrée dans l'approche pédagogique narrative, cette activité de mise en scène des vignettes offre de nouvelles perspectives pédagogiques et éthiques pour les étudiants, les enseignants et le public. Cette activité pédagogique sera reprise à l'Université de Montréal pour l'année 2020., Background/Purpose: As a medical student, I watched in awe and curiosity in the interactions that Molly Penny, the therapeutic clown, fostered with those around her. Therapeutic clowning has been shown to be effective in providing psychosocial support to children, youth, and their families. Learning from Molly Penny as a clown-in-training resulted in one of the most impactful, informative, and transformative experiences for me as a medical trainee and as a person. The “lollipop moment” is a concept that small acts of kindness, humanity, and leadership can make profound positive impacts on others, shared by Drew Dudley, a speaker and author. Summary of the Innovation: The 10-hour therapeutic clowning elective for pre-clerkship medical students aims to help develop listening, sensitivity, creativity, and communication skills to effectively build rapport. As well as, encourage reflecting on the role of laughter, play, and humour in healing and reconciling aspects of psychosocial and physical determinants of health. A Lollipop Moments Day, the sharing of stories and laughter through lollipops, was brought to fruition with the help of hospital staff and children, youth, and their families. Conclusion: We can help facilitate the sharing of stories that shed more light on the experiences that make us human and connected through something as simple as sharing a lollipop or a sticker, to enhance and make more bearable the moments in hospital. We hope to help catalyze a movement and acknowledgement that small gestures, words, and actions can have a powerful cumulative effect on society and our culture of how we interact and treat one another, starting in the hospital., Background/Purpose: Dans le cadre de la refonte du programme de médecine fondée sur un parcours de professionnalisation, nous avons construit une activité pédagogique dédiée à l'acquisition des compétences en gestion de projet et à la mise en œuvre de projets dans la communauté. Summary of the Innovation: L'activité se déroule sur une année de formation et comprend 4 phases au projet : l'identification, la planification, la réalisation et la clôture du projet. Chaque projet est réalisé par une équipe de 5 à 8 étudiants supervisés par un professeur et en partenariat avec un organisme communautaire. Les méthodes pédagogiques incluent des ateliers pratiques et réflexifs, des rencontres avec les superviseurs et les partenaires. Les idées de projets sont sélectionnées en fonction des objectifs, des besoins de la communauté, de l'impact et de la faisabilité. La planification comprend l'échéancier, l'analyse des parties prenantes, les prévisions budgétaires, l'analyse des risques et les indicateurs de performance. La réalisation comprend le plan de communication, la gestion des problèmes et des risques ainsi que le suivi de l'échéancier, du budget et de la qualité des livrables. Le projet se termine par la production d'un rapport de clôture et des présentations en classe et auprès des partenaires. L'évaluation multi sources s'appuie sur la rétroaction par les pairs et les partenaires, les observations directes des superviseurs et les travaux livrés à chaque phase du projet. Conclusion: La participation aux différents ateliers de même que la mise en oeuvre des projets permettent le développement de meilleures pratiques de gestion, du leadership, du travail collaboratif et de l'engagement communautaire. L'activité permet aussi de créer des liens entre la clientèle étudiante, la communauté et la Faculté., Background/Purpose: Le rôle de gestionnaire fait partie intégrante d'une pratique médicale durable. Il gagne à être explicité et développé durant tout le cursus de formation et réfère aux rôles CanMeds de leader, de collaborateur et de professionnel. Dans le cadre de la refonte du programme médecine, nous avons construit des activités pédagogiques intégrées et longitudinales soutenant le développement du rôle de gestionnaire. Summary of the Innovation: Les activités pédagogiques préparent les étudiants à gérer leur pratique médicale et à exercer leur leadership au sein du système de santé. Elles s'appuient sur les fonctions de gestion : planifier, développer (mise en œuvre), contrôler et autoréguler et supportent la pratique réflexive et le développement de l'agir compétent en situation réelle. La 1ère étape adresse la gestion individuelle des études et de la vie personnelle incluant les styles de leadership, les meilleures pratiques de gestion du temps, des finances, du stress et des stratégies d'études. La 2e étape est consacrée à la gestion d'un projet que les étudiants réalisent en équipe dans la communauté. La 3e étape aborde les règles, le fonctionnement et l'organisation des milieux de soins afin d'amorcer la gestion clinique et l'amélioration de la qualité des soins. L'évaluation est fondée sur des examens, des travaux écrits, des livrables, des analyses réflexives ainsi que sur des évaluations multi-sources. Conclusion: Le développement du rôle de gestionnaire et de leader s'est réalisé dans des activités adaptées à chaque niveau de formation. Les professeurs soulignent leur pertinence pour la pratique et le mieux-être des futurs médecins. Les étudiants apprécient la mise en application des meilleures pratiques de gestion de même que les occasions de développer leur leadership et le travail en équipe., Background/Purpose: Community-based service learning (CBSL) placements could be designed to train medical students as “Health Advocates”. Although the primary intended beneficiary of service-learning is both the recipient of the services and the provider, little is known about the experience of community partners. Purpose is to understand how partner community organizations (PCOs) perceive their role in service-learning, the benefits of participating in service learning with medical students, barriers and facilitators to this partnership, and whether CBSL is effectively teaching medical students about their role in advocacy. Methods: This is a qualitative program evaluation of a service-learning course in the University of Toronto medical school. In-depth interviews were performed with 5-10 community partners identified through purposive sampling strategies. Data were recorded, transcribed and coded using deductive and inductive coding by two independent coders. Codes will be analyzed for themes, supported by group discussion and memos. Results: Themes included advocacy, service learning and course improvement feedback. A few PCOs described CBSL as a mutually beneficial activity but felt their goal was to help students be “better” doctors. Many PCOs described themselves as “medically-adjacent” and tended to give students medically-related tasks. The PCOs that participated as longitudinal co-tutors for delivery the HC curriculum felt empowered and several requested more information on the medical students' in-class curriculum to improve their role in educating students on advocacy. Conclusion: In identifying the experiences of community partners, service learning curricula can be refined to address the needs of community agencies and improve advocacy training for medical students., Background/Purpose: As residents progress through their training, they experience certain events that have a lasting impact. These 'critical events' may either be associated with positive or negative emotions. These events stand out due to their uniqueness, emotional context, clinical situation or educational weight and are consolidated after a period of active reflection. This project seeks to understand 1) the types of critical events residents experience during their training, 2) if these events are recognized by their supervisors and if so, how this modulates residents' reflection on them, and 3) how these events relate to residents' development of professional identity. Methods: Participants were recruited via email advertisements and purposeful sampling. Data was collected via guided interviews of senior internal medicine residents. Participants described a 'critical event' in their training and asked a series of standardized and follow-up questions by a near-peer researcher. Twelve interviews were analyzed utilizing constructivist grounded theory after being conducted to thematic saturation. Results: Analysis of the narratives showed that 7/12 (58%) of the critical events were positive experiences. Positive events are characterized by responsibility, transition points and are grounded in the patient relationship. Negative events are characterized by isolation and perceived lack of supervisor support. All events are not explicitly recognized by supervisors. Conclusion: Senior internal medicine residents easily identified critical events from training. Positive and negative events are experienced and reflected upon differently. Residents desire supervisors to play an active role in fostering reflective practice, which may mitigate future negative effects of these experiences. These experiences may be better understood utilizing transformative learning theory., Background/Purpose: Malignant Hematology is in a new era of exciting novel treatment regimens and modalities, including CAR-T (Chimeric Antigen Receptor T-cells) and BiTE (Bi-specific T-cell Engaging) antibodies. Current trainees require an ever-increasing knowledge and skillset to deliver high quality care to more complex patients. There is limited evidence on the educational needs of hematology residents with these emerging complexities. Moreover, these educational needs themselves are poorly-defined. As a first step, we sought to perform a detailed needs assessment to identify knowledge gaps in our learners. It is our intention to use this information to aid in developing an educational tool incorporating these novel elements. Methods: Every year Hematology residents in Canada attend the National Hematology Retreat in Toronto, Ontario for a weekend of educational activities, which also serves as preparation for the Royal College of Physicians and Surgeons Hematology certification exam. Residents were invited to participate in a questionnaire to identify perceived and unperceived needs. They were asked to select topics of perceived needs from a pre-selected list. This was followed by a knowledge assessment using case-based questions in leukemia, myeloma, lymphoma, and Blood and Marrow Transplantation [BMT]. The study is approved by the University of Toronto Research Ethics Board. Data were analyzed descriptively as needed. Mean total scores from the case-based questions were compared between training years using one way ANOVA. All statistical calculations were performed using SPSS version 26. Results: Over two years we surveyed from 85 out of approximately 150 Canadian Hematology residents attending the retreat. Among the respondents, 2 were PGY-3 or lower, 24 were PGY-4, 31 were PGY-5, and 28 were PGY-6 and above. 3 respondents had done the survey previously. Of our pre-selected topics list, residents perceived the most common knowledge gaps existed in management of BMT complications, followed by molecular testing (especially genomics), and novel immune and cellular therapies. The top choices differed in the PGY-4 year (BMT complications, novel immune and cellular therapies and emergency AML complications, Figure 1). Conclusion: Needs assessments are a useful tool in assessing background knowledge, identifying perceived and unperceived needs of trainees, and can be used towards creating a resource that accounts for learning priorities. Our needs assessment of hematology residents across Canada demonstrated that: 1) Knowledge gaps exist among residents at different levels of training, particularly in BMT, compared to other areas of Malignant Hematology. Moreover, this was perceived by residents themselves. 2) Learning priorities of residents may change over the course of their training. Our next step is to assess what specific gaps residents have in molecular testing and CAR-T cells and potentially create an electronic based learning tool., Background/Purpose: There is ongoing debate regarding the optimal approach to overnight call, given the increased interest in duty hour restrictions among surgical programs in Canada. Thus far General Surgery programs have avoided a night-float approach. The purpose of this study is to evaluate a mixed short-segment night-float (MSSNF) call schedule compared to traditional call in subjective educational experience among junior residents. Methods: PGY1 residents on general surgery were surveyed at completion of block on their satisfaction with educational experience, assessment of workload and ability to attend teaching after either a block of traditional 24-hour call schedule or the MSSNF schedule (5 consecutive 5pm-7am in-house shifts with daytime alloted to post-call recovery, and two non-consecutive 24-hour weekend shifts per month). Results: Of the 44 surveyed, 41% were surgical residents. Residents ranked overnight consults as the greatest source of learning on GS. More residents in MSSNF felt overnight workload was less compared to other rotations (41% vs. 5%), and 36% more felt call was less with MSSNF. More found overnight work a useful educational experience with MSSNF (91% vs. 41%), and 91% were able to attend teaching (vs. 86% traditional). Conclusion: MSSNF residents felt a subjective decreased burden of overnight workload, increased subjective educational experience and felt they were doing less call overall compared to traditional schedules. Summary: MSSNF is a feasible and well-received method of resident call scheduling which may improve subjective opinions of the generally strenuous general surgery call., Background/Purpose: L'observation directe (OD) est un élément clé dans les stratégies d'enseignement et d'évaluation utilisées en approche par compétences. Les bénéfices de l'OD ont déjà été rapportés dans la littérature. Toutefois, à l'urgence, les résidents sont seulement observés 3,6 % du temps. Une des principales barrières étant l'achalandage et la crainte d'une diminution du débit. Par contre, cela n'a jamais été formellement étudié dans le passé. L'objectif primaire de l'étude est d'évaluer l'impact de l'OD sur le débit à l'urgence. L'objectif secondaire est l'évaluation de l'impact de l'OD sur l'exposition des résidents. Methods: Il s'agit d'un projet de cohorte prospective unicentrique impliquant des résidents R2-R4 en médecine d'urgence spécialisée. Ceux-ci ont accompli deux types de quarts de travails. Ceux usuels (U), sans modification par rapport à la pratique établie, et ceux d'OD où le quart entier était effectué en OD. Pour l'analyse statistique, des tests de Mann-Whitney ont été utilisés. Results: 18 U et 26 OD furent effectués. Une différence significative fut démontrée en défaveur de l'OD en regard du débit total (U = 15; OD = 12, p = 0,02). Par contre, l'exposition des résidents est significativement plus élevée en faveur de l'OD (U = 7; OD = 9 p =, Background/Purpose: Best practices in applications & selection (BPAS) for postgraduate medical education (PGME) are now promoted by the AFMC and CaRMS. In this study, we aimed to identify areas for improvement (AFI) in the PGME selection processes at Université de Montréal (UdeM). Methods: An online questionnaire was sent to 73 PD at UdeM to assess selection procedures related to BPAS. Results: 54 PD (74% participation) completed the online survey. Most programs had well-defined selection tools, file review steps and desired candidate characteristics (94%, 80% and 61%, respectively), but fewer programs had clear “do not rank” (DNR) criteria, procedures to disclose conflict of interests (COI) or methods to manage data obtained outside the formal selection process (32%, 11% and 2%, respectively). Only 55% of programs openly disclosed to candidates how they generated the final ranking list. Less than 2/3 of programs formally trained their admission committee members for file review and interview processes (57% and 41%, respectively). Only 8% of interviews were performed completely independently, without access to the rest of the applicant's file. A minority of programs (10%) performed psychometric analysis of their selection tools' data. Conclusion: This study identified many AFI and challenges in our PGME selection processes that will help to guide BPAS implementation in our institution, including improving transparency for some elements (DNR criteria, COI disclosure and final ranking method), increasing admission committee training and obtaining more resources for psychometric analysis of their selection tools., Background/Purpose: Le nouveau guide alimentaire canadien publié en janvier 2019 apporte un changement de paradigme en santé nécessaire. Dû à un rythme de vie effréné, l'intégration de saines habitudes alimentaires est plus difficile à concilier au quotidien. Le désir d'efficacité de la population canadienne influence leur prise de décision, de l'épicerie à l'assiette, en priorisant les produits transformés pouvant être préparés et consommés rapidement. À l'aide de 3 sphères d'intervention, soit l'érudition, le partage des connaissances et l'implication sociale, Pots Maison répond à une lacune entourant les connaissances en nutrition de la communauté médicale et du grand public dans le but de démocratiser l'accès à l'information entourant la saine alimentation. Summary of the Innovation: L'élément rassembleur des 3 sphères d'intervention est le e-book, contenant 10 recettes et 7 capsules de professionnels de la santé. Grâce à la promotion du livre à l'école, sur les médias sociaux et à la radio locale, plus de 3000$ de dons ont été remis au centre de pédiatrie sociale de Trois-Rivières. Pour inciter les étudiants et les jeunes de la pédiatrie sociale à cuisiner avec plaisir, 2 ateliers de cuisine ont été organisés. Pour démystifier le guide alimentaire, une nutritionniste a donné une conférence à ce sujet. En 2019, il y a eu 50 participants aux activités et plus d'une centaine de personnes qui ont accédé au livre. Conclusion: Par une réponse interdisciplinaire adaptée, ce projet propose une solution à la complexité de l'information sur la nutrition. Les participants montrent un sincère intérêt à la saine alimentation et la préparation collective de repas. L'encadrement offert permet de développer une meilleure confiance en cuisine. Le projet sera renouvelé pour l'année à venir avec l'ajout d'enjeux alimentaires d'actualité., Background/Purpose: Educators have effective methods for imparting the knowledge and procedures necessary for effective palpation. They have not settled on methods for cultivating tactile expertise - the ability to appreciate subtle distinctions among the perceptual features that distinguish normal from abnormal tissue. We conducted a meta-analysis to determine the scope and effectiveness of educational activities used to develop tactile expertise. Methods: We searched MEDLINE comprehensively using terms cognate with education and palpation and selected those that compared participants' abilities to interpret the diagnostic information gathered through palpation before and after training. We excluded studies that measured only changes in knowledge, skills, or attitudes. We extracted information about the educational objective, the learning activities, and their effect. Results: Twenty-three studies involving 1,466 participants met our inclusion criteria. They focused predominantly on three educational objectives: the ability to detect masses in breast tissue, evaluate prostate tissue, and locate anatomical structures. Three educational activities, implemented in tandem, were used to impart these abilities: lectures, demonstrations, and guided practice. The effect of these activities, pooled across studies that compared the abilities of trained to untrained participants was large (SMD = 0.93 ([95% CI, 0.80, 1.05]). Conclusion: Brief interventions of have a large effect on the abilities of novices to interpret the information they gather with their fingers and hands, particularly when the abilities are measured immediately after training. The abilities are inadequate for clinical decision-making, but they could be improved by recognizing the importance of tactile expertise in palpation and systematically designing instruction for this outcome., Background/Purpose: The University of Toronto's MD Program collaborates with local community agencies, organizations and municipal governments to work on the issues they face to enhance community health and institutional connectivity, while identifying experiential learning opportunities to engage students in the communities within which they learn and live. The Role Model Moms (RMM) program supports low-income mothers completing their General Equivalency Diplomas. RMM and the University of Toronto's MD program collaborated to create a program providing tailored information on post-secondary education (PSE) for RMM participants. Summary of the Innovation: A collaborative, community-engagement approach was utilized to develop the RMM Post-Secondary Academy event, which sought to bridge gaps in existing PSE orientation resources targeting this marginalized group. The half-day event has run for 3 years involving 42, 45, and 38 women, respectively, and numerous undergraduate and MD student volunteers. Events were evaluated via facilitator debriefing sessions, and participant post-event surveys and interviews, with results analyzed using basic statistics and descriptive thematic analysis. Participants gained a positive understanding and outlook on PSE. Their concerns regarding PSE included family, financial, and academic barriers. Event feedback informed program development. Conclusion: Collaboration enabled minimal strain on existing PS resources, individual facilitators and student volunteers, while community-engagement ensured content was relevant to the target audience. This pipeline program provides a replicable model for responsive community programming and may serve as a framework for future programs to increase access, equality and diversity in PS for underrepresented groups., Background/Purpose: A recent explosion in calls for supporting developing physicians' professional identity formation (PIF) in the medical education literature has been followed by an abundance of educational innovations purporting to foster medical students' PIF. However, between the flurry of interest in supporting PIF and related innovations there exists a gap in our understanding of the ways in which theory building and empiric research are converging. We present the results of a scoping review which examines the landscape of PIF research in medical education so as to orient medical educators and researchers to needed next steps. Methods: This study followed a step-wise scoping review methodology which first involved the research team identifying the research question. We wanted to understand how the conversation around professional identity formation had evolved in the medical education literature over the past ten years, how the current conversations are framed, and what gaps are apparent in the literature. In keeping with scoping review methodology, a wide approach was developed in order to ensure breadth. The process of delimiting the search parameters was iterative; continued conversations between the researchers determined general scope as well as implications of various stances. Inclusion and exclusion criteria were applied to the complete list of 256 studies resulting in the extraction of 166 number of articles. A total of 90 articles were included and Copies of full articles were read by all researchers as we engaged in a more in-depth analysis. Results: Qualitative data were extracted from the publications, analyzed and sorted according to identified themes. The information collected about empiric research papers were • Study “demographics” (title, author(s), publication year, journal, setting) • Purpose of study • Study population • Intervention or phenomenon under study • Methodology and methods • Outcomes • Relevant results The information collected from non-empirical studies included: • Study “demographics” (author(s), publication year, journal, setting) • Purpose/objective of article • Context • Type of article (commentary, intervention/innovation description etc) • Framework/ontology/epistemology/model • Implications Conclusion: Overall this scoping review found a paucity published papers specifically outlining why it is important to study PIF. Most published studies left this for the reader to make major assumptions. As well conceptual frameworks were lacking in the reviewed papers. There were also little articulation of what 'makes a good physician” in other words, what is the goal of professional identity formation for those training to become physicians in the future. Related to this there is little discussion of how medical education is supporting the development of these traits. Finally, outcome studies of PIF curriculum and interventions are needed., Background/Purpose: Finding research opportunities often occurs as a necessary expectation in medical school. Many would consider these placements as part of the hidden curriculum; although not a part of most official undergraduate curricula, they are an expectation for staying competitive when applying to residency programs. However, little guidance exists for medical students, undergraduate educators, or clinical researchers interested in creating valuable non-traditional research experiences. Summary of the Innovation: The aim of this project is to use knowledge translation (KT) science to describe the content knowledge and practical skills acquired during the Canadian Medical Protective Association's (CMPA) medical student internship; a unique summer program designed to provide undergraduate medical students with an non-traditional training experience in a non-profit, medico-legal setting. Our project utilizes the KT Planning Template and KT Game from the Sick Kids Learning Institute as a framework to provide a rich description of the CMPA's 2019 summer program as well as the cumulative reflections of three undergraduate students. Conclusion: This project demonstrates that students gained valuable content knowledge and practical skills aligned with CanMEDS roles during this summer internship. It also provides a helpful tool for medical educators interested in a design framework for future undergraduate medical student opportunities. A preliminary internal evaluation demonstrated that this KT framework was effective in disseminating information and increasing awareness of the knowledge and skills acquired during the medical student experience., Background/Purpose: The entrance to clerkship represents a challenging transition between the didactic preclinical curriculum and the unfamiliar practical skill-set of patient care. A pilot resident-led initiative was created to stimulate process learning of these under-represented day-to-day skills, including creating clinical assessments, navigating documentation, and medical communication. Summary of the Innovation: The pilot initiative was created as a longitudinal opt-in program for second-year students over the academic year. Four small-group resident-led sessions were run, each focused on developing separate practical clinical skills through interactive cases. Given the success of this program, it was subsequently incorporated as a mandatory workshop in the University of Toronto's formal Transition to Clerkship undergraduate curriculum. The goals of the workshop were to orient new clerks to their upcoming clinical responsibilities and develop a rotation-specific approach to a new patient. Using a novel framework for patient assessment (abbreviated EARWORM), students were guided through two interactive cases. Students created their own plans and received feedback on their oral presentations. Students were then surveyed on their confidence with the relevant skills. Conclusion: After the workshop, student respondents felt more comfortable using an organized approach to a new patient (90.3%), creating a differential diagnosis (77.4%), formulating a plan (74.2%), and presenting a succinct case summary (90.3%). 91% stated they found practical resident feedback useful and 84% felt more comfortable entering clerkship. Overall, our program has strong potential to strengthen the transition to clinical practice, highlighting the value of simulated case practice and personalized near-peer mentorship in enhancing clinical competence., Background/Purpose: Cognitive flow is a state in which individuals experience heightened awareness, performance, and reward. Although this state has been deeply explored and applied in elite sport and psychology, less is known about flow states in healthcare settings. This systematic review sought to summarize the information currently available on the phenomenon of flow in healthcare and to identify gaps in knowledge on this concept. Methods: A systematic search using keywords related to cognitive flow, positive psychology, the zone, healthcare, and clinical practice was conducted. Two independent reviewers screened all articles and extracted data pertaining to study characteristics, study design, and psychometric properties. Data pertaining to discipline and salient results were noted. Results: 4834 articles were initially identified; after duplicate removal, 4824 remained. 207 articles were included in full-text review after title and abstract screening. Overall, we found a paucity of literature on flow in healthcare settings. Many articles focused on workplace engagement and enjoyment. Common themes included the potential impacts of engaged and disengaged workers in healthcare, prevalence of burnout and stress in healthcare, the importance of work environment on work engagement, and the benefits of self-awareness and mindfulness in both work and learning. Conclusion: Understanding flow states in healthcare may lead to new avenues for combating burnout, enhancing career satisfaction, and promoting wellness among providers. Future studies are needed to more deeply understand how flow is experienced in clinical settings, and how we might tailor training to help students achieve flow., Background/Purpose: The COMPASS curriculum was initiated at the McMaster DeGroote School of Medicine in 2006 with the tenets: concept-oriented, multidisciplinary, problem-based, practice for transfer, simulations in clerkship, and streaming. The practice to transfer component concerns the ability to transfer previous knowledge, applying it in a different context which is central in this innovative curricular project. The Family Medicine clerkship program developed a new E-learning platform by revisiting pre-clerkship Problem-based learning cases, adding layers of complexity to foster clinical knowledge translation in clerkship during which the cases are completed asynchronously and in synchronous tutorials. Summary of the Innovation: Building on the foundation of curriculum development strategies and influence of adult learning theory, a Family Medicine integrated curriculum was designed by modifying preclerkship cases to have a practice to transfer focus. Students prepare for tutorial using the new E-learning modular platform. The modules integrate preclerkship and clerkship curriculum, including knowledge-check questions to promote self-assessment. The repetition of formative assessment aims to promote learner self-assessment and preparedness for the clinical decision making focused exit examination. The “super-tutorials” were designed to enhance interaction between clerks and a maestro (content expert), and the E-learning platform to enhance student engagement using polling questions and interactive features. Conclusion: The development of asynchronous learning modules and synchronous learning opportunities through maestro-led “super-tutorials” allows for students to recall previous knowledge concepts and apply them in more complex situations thereby facilitating knowledge transfer. The maestro challenges this knowledge by guiding students through novel scenarios, which further develops knowledge transfer, and prepares students for diverse clinical scenarios., Background/Purpose: There are limited pre-residency opportunities for students to experience the breadth of internal medicine (IM). IMED is a 2-week program involving observerships, career talks and hands-on workshops in nine medicine subspecialties. Our objectives were to investigate whether the current IMED structure appropriately altered documented biases regarding a career in IM and which aspect of IMED students found most helpful in exploring these misconceptions. Methods: Surveys were administered to three groups (n=16): IMED participants who completed pre- and post-program surveys; “General control” participants who did not apply to IMED and “applied Control” participants who unsuccessfully applied. Scores were compared using Wilcoxon signed-rank and rank-sum tests for paired and unpaired data, respectively. Results: 81% of participants reported a change in perception about the hours, work-life balance and job prospects as an internist, while 63% of participants reported a change in perception regarding procedural skill required. 81% of IMED participants reported that they were more likely to pursue IM following IMED. When students reported a change in their bias towards a career as an internist, 79% of the time this change was attributed to career talks. However, despite these self-reported results, there were no significant differences in misconception scores between groups. Conclusion: IMED successfully improved pre-clerkship students' self-perceived understanding of a career as an internist. Career talks were the most valuable resource for students in altering misconceptions. In the future, our questionnaire needs adjusting. Participants felt that they had a change in their perception; however, due to the way questions were posed and scored, our objective data was not consistent with participants' opinions., Background/Purpose: Problem-based learning (PBL) has been recognized and used for decades in medical education to promote self-learning and clinical reasoning. Studying in a PBL curriculum requires self-regulated learning (SRL). This skill is not easily integrated, and students are lacking effective strategies to direct their own learning. Concepts mapping (CM) is a recognized strategy to support student SRL but several challenges exist. For students, CM may be a lengthy and strenuous process with difficulties combining and navigating thousands of concept maps. For educators, providing timely feedback can be a struggle. To address these issues, a software platform with strong cognitive foundations has been developed to support learning, collaboration and problem solving. The project stems from 8 years of research and developments in our engineering faculty and is being adapted to medical PBL program with promising results. Summary of the Innovation: Relate! allows learners to organise knowledge, documents and references from all courses in one central place through innovative “extended concept maps”. It is a collaborative platform that gives spaces for teams to build shared understanding, and it has a mechanism for teachers to evaluate and interact with students. Fifteen engineering students participated in qualitative interviews. They identified that it is a valuable tool to organise and support learning, and that it improves overview of the work compared to traditional CM and note books. Conclusion: Preliminary results suggest that this app offer innovative and concrete means of supporting external feedback and scaffolding of knowledge. Application to medical education may be interesting as it is aligned with PBL, self-regulated learning and the need to integrate a growing body of knowledge., Background/Purpose: Objective Structured Clinical Examinations (OSCEs), dominant in health professions education (HPE) over the last forty years, seek to standardise assessment of and for practitioners. Critical research has expressed concern about the unintended but undesirable consequences of OSCEs. From 2023 the General Medical Council (GMC), the regulatory body for doctors in the United Kingdom (UK), will increase regulation in graduating assessments, to include OSCEs, bringing the UK in line with North America. This increased emphasis on objective, standardized and therefore accountable assessments creates difficulties for faculty keen to involve real patients. Methods: This PhD used the method/theory of Institutional Ethnography, exploring increasing regulation into graduating OSCEs in a UK medical school. Data collection involved ethnographic observations, formal interviews, informal “chats” and the texts these people used. The aim was to explicate the work in OSCEs on the ground and in tandem, explore how and where this work was organized from. Results: The need to standardize was a dominant thematic. I will present composite accounts of how students interacted with simulated patients in contrast to interactions between students and real patients in graduating OSCEs. These accounts allow differing emphases to be highlighted and depict what is lost in scripted interactions within regulation-mandated accountability. Conclusion: Real patients offer disruption to extreme standardization imposed through regulation; recalibration of thinking and commitment is required to promote unstandardized and unstandardizable person to person interactions. These 'non-insiders' push educators to question abstraction and obscurity in assessment and to focus on real clinical practice these students are about to embark on., Background/Purpose: Point of care ultrasonography (POCUS) is increasingly being incorporated into residency education. Despite this, there is no clear scanning standards, resulting in variable education being delivered across centres. This consensus study seeks to define the minimal criteria for all intended uses of lung POCUS for Canadian internal medicine training programs. Achieving consensus for minimal criteria will support standardization and enhance the overall quality of POCUS education. Methods: Two independent investigators drafted a list of minimal criteria for lung POCUS, based upon a review of the literature. Minimal criteria refers to standards that a trainee must successfully demonstrate or achieve in order to be considered minimally acceptable. This draft criteria was then piloted as a survey on 14 internal medicine and family medicine physicians with at least 1 month of POCUS training. Suggestions were used to create a preliminary final criteria that was then surveyed to 10 international POCUS experts. Inclusion criteria for POCUS experts included the following: ≥ 1 year of POCUS fellowship training or ≥ 3 year experience in teaching and assessing POCUS and ≥ 3 peer reviewed POCUS-related publications. Experts then completed 3 rounds of the 100-item online survey; consensus was defined as agreement by 70% or more. Results: The response rate for the survey was 100% in all 3 rounds. In total 74 items met consensus for inclusion (51 in round 1, 15 in round 2 and 8 in round 3), 24 met consensus for exclusion (17 in round 1, 5 in round 2 and 2 in round 3), and 2 did not meet consensus. Conclusion: In this study, we used consensus methods to achieve a 74-item minimal criteria standard for lung ultrasound in Canadian internal medicine training programs. This set of criteria will help standardize teaching, performance, and assessments, and ultimately enhance the quality of education in this evolving technique., Background/Purpose: Medical schools must ensure the timeliness of clinical assessment feedback for students. This is problematic when programs are delivered across multiple sites with a large pool of instructors. A five year quality improvement program has been ongoing to address the timeliness of clinical assessments. The purpose of this study is to evaluate the effectiveness of this initiative. Summary of the Innovation: This educational quality improvement initiative consisted of three parts. First, a data dashboard was developed to monitor the submission of assessment forms. Submissions were tracked to monitor the timeliness of feedback, relative to the midpoint and end point of each clerkship. Second, this dashboard was reviewed monthly by MD Program committees, such that all clerkships could see each other's progress. Third, a reminder process triggered follow-up with appropriate faculty when feedback from a rotation was late, potentially leading to non-compliance with program expectations. Over the past five years, 9878 assessment forms were tracked. A total of 0.8 % of summative and 2.1% of formative assessment forms were found to be non-compliant with program expectations for timely submission. Conclusion: Our project demonstrates the effectiveness of an electronic dashboard, combined with stakeholder buy-in and continuous monitoring, in facilitating compliance with the provision of timely feedback to students. Further research in this area will examine other methods of compliance encouragement which could build on the success of this project., Background/Purpose: Diabetic foot wounds comprise a third of diabetes-related healthcare expenditures, and are the primary cause of amputation in Canada.Few studies focus on how to teach and assess wound management. Given the importance of 'assessment for learning' in Competence by Design, we aimed to develop, and examine specific sources of validity evidence for, an assessment tool of wound management competencies. Methods: We organized our tool development and validation process using Kane's framework. Using a nominal group process involving 9 Canadian experts in diabetic wound management, we developed the tool items, and two 10-minute simulation-based testing scenarios.We then assessed 74 participants' (61 physicians, 13 non-physicians) performance during the two scenarios: 44 novices (500).Two assessors independently rated participants using our tool.Reliability was evaluated using Generalizability Theory. Test-retest reliability was measured with intraclass correlation coefficient (ICC) comparing raters' scores across scenarios. We also compared performance scores across the three levels of experience Results: We organized our tool development and validation process using Kane's framework. Using a nominal group process involving 9 Canadian experts in diabetic wound management, we developed the tool items, and two 10-minute simulation-based testing scenarios.We then assessed 74 participants' (61 physicians, 13 non-physicians) performance during the two scenarios: 44 novices (500).Two assessors independently rated participants using our tool.Reliability was evaluated using Generalizability Theory. Test-retest reliability was measured with intraclass correlation coefficient (ICC) comparing raters' scores across scenarios. We also compared performance scores across the three levels of experience Conclusion: The accumulated validity evidence suggests our tool can be used to assess novice clinicians' competence in diabetic wound management during simulated cases.We plan to continue establishing validity evidence for use in other settings., Background/Purpose: Workplace-based assessment (WBA) is a critical component of competency-based medical education (CBME). Literature on WBA of performance during overnight call (e.g. post-call), however, is limited. We sought to evaluate a new post-call assessment tool for subspecialty overnight call within a paediatric residency. Methods: Web-based surveys were sent to residents before tool implementation and monthly afterwards. Surveys explored frequency of actionable feedback provided and Likert-scaled opinions of tool usefulness in facilitating feedback (in CanMEDS Medical Expert [ME] and Manager/Leader [M/L] roles), feasibility within clinical workflows, preference for a longer (milestones specified) or shorter (assessment of entrustment, comments alone) tool, and qualitative comments. Quantitative data was summarized using descriptive statistics. Qualitative data was coded to identify themes. Results: Response rates averaged 41% (average monthly n = 12). Median shifts with ME feedback increased 2 months post-tool (3/4 shifts worked, vs 1 pre-tool), but returned near baseline at 4 months. Shifts with M/L feedback (0-1.5/4 vs 1) was unchanged. Residents were divided between agreement (6/16) and disagreement (5/16) on the tool's usefulness facilitating ME feedback, and disagreed on its facilitating M/L feedback (8/16) and feasibility within clinical workflows (10/16). Qualitative analysis revealed themes around non-actionable feedback; barriers to tool feasibility including handover structure, fellow availability and knowledge, interpersonal burden, and platform issues; and preference for shorter tools. Conclusion: These findings identify key gaps in using WBA to meet CBME goals of increasing competency-developing feedback. Addressing gaps within feedback quality and factors influencing tool feasibility and logistics is essential for successful CBD implementation., Background/Purpose: The Multiple Mini Interview (MMI) has demonstrated validity evidence for personal competencies as indicated by the original publications' reliability values of 0.65 to 0.78. More medical schools are developing their own local MMIs using specific competencies based on mission, values, population served, and applicant pool. It is essential that schools gather validity evidence when using high stakes assessments. Methods: In a review of 10 MMI papers, five cited reliability, ranging from 0.47 to 0.89 and none described undertaking a validation process. Kane's validity framework was applied to a locally developed MMI in the US to assess its evidence. The four inferences or phases, scoring, generalizability, extrapolation, and implication were used to identify validity threats and possible solutions. Results: The threats to validity consisted of systematic error from rater variability and construct under-representation identified in the scoring and generalizability phases. Rater variability was managed with rater training and feedback. CUR was addressed by blueprinting scenarios and removing scenarios that were too difficult or too easy. The reliability of the MMI was 0.65, indicating that the majority of the variance was attributable to the applicant. As real-world data is not available, the extrapolation inference was supported by content validity (matched to AAMC's recommendation) and convergent validity (r=0.40 between MMI and CASPer). Conclusion: Using a consistent validity framework will help developers/designers of a local MMI support admission decisions. It will also allow us to compare and contrast MMI variation to understand the critical components in MMI implementation in different contexts., Background/Purpose: In 2010, the University of Manitoba MD program began a process of curriculum renewal. Implemented over the next five years, the new curriculum included substantial changes to both the format and content of the curricula. The Office of Educational and Faculty Development is conducting a multi-method evaluation of the curriculum. One question in the study is: Does an integrated, spiral curriculum change student's self-assessed learning? This presentation will explore the influence of gender on perceived competency of students at the end of clerkship, both before and after implementation of the new curriculum. Methods: Students were asked to self-assess their performance on MD program curricular objectives at various points during their studies. Students rated their perceived competence on each of the MD program's learning objectives, using a paper survey and a five-point Likert scale. Data were analyzed with the Kruskall-Wallis test using SPSSv25. Results: Statistically significant differences were found for a number of program objectives, with female students rating objectives related to the Medical Expert, Communicator, Collaborator, Health Advocate and Professional CanMEDs Roles higher, and males rating objectives related to the Scholar, and Manager higher. Conclusion: There may be gender related differences in self-assessed competence for CanMEDs domains. These may have implications for exploring concepts such as imposter syndrome, clinical confidence, and gender-based differences in assessment of learning. Further study is needed to determine the influence of other factors, including student outcomes and admission variables, on self-assessed competence., Background/Purpose: L'Examen d'Aptitude du Conseil Médical Canadien (EACMC-1) requiert une préparation échelonnée sur plusieurs mois, années. Conscients des enjeux de cet examen, les étudiants éprouvent de l'anxiété durant la préparation ainsi qu'au moment de l'examen. Le Vice-Décanat de Premier Cycle de l'Université de Montréal cherche à réduire cette anxiété en offrant du soutien et des outils dans la préparation du EACMC. Methods: En partenariat avec le Centre étudiant de soutien à la réussite, nous avons mené des groupes de discussion avec des résidents de première année ayant bien réussis le EACMC. Les discussions se sont concentrées sur les stratégies utilisées durant la préparation à l'examen et durant l'examen. Un groupe de discussion ainsi qu'un questionnaire a été envoyé à l'ensemble des externes qui s'apprêtent à faire l'examen, afin de connaître leur besoins lors de cette préparation. Results: Durant la préparation à l'examen, les stratégies utilisées chez les résidents ayant réussis l'examen sont celles d'une gestion du temps efficace et d'une bonne utilisation des ressources disponibles. Le développement d'une fine connaissance de leur profil d'apprentissage en adaptant leur calendrier, la matière à réviser et les ressources utilisées mène au succès. Ils s'assurent de créer les conditions idéales pour étudier (seul et/ou en groupe, etc.), d'avoir les outils nécessaires (livres, et banque de questions de pratique) et de conserver une vie équilibrée (sommeil, alimentation et loisir). Conclusion: La mise en évidence de stratégies efficaces et le profil d'apprentissage de l'étudiant pourrait contribuer à la diminution de l'anxiété lors de la préparation du EACMC., Background/Purpose: MD/PhD programs are relatively new in Canada and are a key route to training the next generation of clinician-scientists. However, MD/PhD programs vary substantially by structure, funding and mentorship opportunities, and there exists a paucity of data on the overall student successes and challenges. The goal of this study is to assess objective and subjective metrics of the MD/PhD program at the University of Ottawa. Methods: Students in all cohorts were invited to complete a 58-question survey, and the resulting data were subsequently analyzed by descriptive statistics. Results: On recruitment: Tuition support was considered an essential element in accepting the admission offer, as 47.8% of students would have declined admission without full UGME tuition coverage. On graduate training: The vast majority of respondents (78%) expressed interest in taking graduate courses designed specifically for clinician-scientist trainees, which are currently absent. Regarding scientific activities: MD/PhD students were heavily engaged in scientific activities, with an average of 8.3 presentations/publications per respondent. On general challenges: Respondents indicated low satisfaction with formal career planning advice (28.6% satisfied/very satisfied) and program transition guidance (22.2%), whereas when delivered informally by peers both were experienced as more satisfying (65.2% and 63.6% respectively). Conclusion: This survey contributes to the growing body of knowledge surrounding the successes and challenges of MD/PhD programs in Canada. The survey template employed is being shared to guide assessments at other institutions. This work is currently in submission at CMAJ Open., Background/Purpose: Field notes (FNs) are used in Family Medicine (FM) residency programs to foster reflective learning and facilitate feedback. Residents document dimensions of one clinical encounter, assess their strengths and weaknesses, and develop action plans to effect a change in practice. This study explored the use of FNs in the University of Manitoba's FM residency program. Methods: This multi-method study examined 520 FNs from 16 recent graduates. Quantitative analysis (frequencies and means) enabled descriptions and comparisons between residency training sites; four themes emerged from inductive content analysis. Results: Residents displayed cyclical variation in the generation of FNs, with peaks coinciding with the start of core FM rotations. The most frequently described Priority Topics were Skin Disorders, Infections, Depression, and pain management. All but 8 of the 99 Priority Topics (addressing complex psychosocial issues) were explored in this data set. Few FNs addressed the domains of Care of First Nations, Inuit, and Metis, Care of the Vulnerable and Underserved, and Behavioural Medicine and the CanMEDS-FM roles of FM - Procedural Skill, Leader/Manager, and Professional. Four themes (Patient-Centered Care, Patient Safety, Achieving Balance, and Confidence) were identified from narrative notes. Conclusion: Vygotsky's Sociocultural Theory of Cognitive Development was proposed as a lens through which to examine factors influencing resident learning. Residents' discomfort with certain topics may be reflected in their avoidance of reflecting upon certain competencies in FNs thus impacting skill acquisition. Further research should explore factors influencing residents' selection of FN topics and how to best assist residents in becoming competent, confident practitioners., Background/Purpose: The advent of competency-based education has led to concerns regarding reductionism in the assessment of clinical competence. This apprehension stems from a frequently utilized, fractionated approach using the assessment of isolated competencies to build a complete picture of clinical competence. In contrast, others argue that the EPA framework complements the construct of competencies, as EPAs describe a unit of work and require a global, holistic approach to the assessment of the various activities of a physician. Methods: We designed a simulation-based workshop during our medical school's Transitions to Residency Course to discern whether the assessment of separate competencies to build a picture of clinical competence is equivalent to the global assessment of EPAs. Each student was assessed using individual competencies mapped to the Core EPAs, a modified supervision scale, and a global statement regarding entrustment and readiness for residency. These assessments were then compared to aggregate workplace-based assessment data on the various individual competencies from the core clerkships as rated by trained assessors and subsequently mapped to each EPA. Results: Assessment data obtained during the Transitions to Residency course using the individual competencies from the EPA toolkits were highly correlated with the assessment of individual competencies obtained from ratings by qualified assessors in the workplace as part of the core clerkships. However, these individual competency-based assessments did not correlate with holistic, EPA-based global supervision scale ratings, entrustment decisions, or perceived readiness for residency. Conclusion: The global assessment of EPAs and the judgement of entrustment appears to be a separate process from aggregating the assessment of individual competencies for raters. This may reflect variations in the approach to global assessment when compared to the assessment of individual competencies as well as the need to consider the construct of trustworthiness in addition to the learner's ability to perform the activities of a physician essential to succeeding in residency during the assessment process., Background/Purpose: Competency-based education (CBE) has been implemented across Canadian post-graduate medical training programs through Competence By Design (CBD). We describe our initial experiences, highlighting perceptions and barriers to facilitate implementation at other centers. Methods: An anonymous online survey was administered to faculty and residents transitioning to CBE (138 respondents) including 1) Queen's Residents (QR)[n= 102], 2) Queen's Faculty (Program Directors and CBME Leads) [n=27]and 3) Canadian Neurology Program Directors (NPD)[n = 9] and analyzed the data using descriptive and inferential statistical techniques. Results: Perceptions were favorable (x̄ = 3.55, SD = 0.71) and 81.58% perceived CBE enhanced training; however, perceptions were more favorable in faculty. QF indicated that CBE did not improve their ability to provide negative feedback. NPDs did not perceive their institution had adequately prepared them. QR did not perceive improved quality of feedback. There was variability in barriers perceived across groups. NPDs were concerned about access to information technology. QF were concerned about resident initiative. QR felt assessment selection and faculty responsiveness to feedback were barriers. Conclusion: Our results indicate Faculty were concerned about reluctance of residents to actively participate in CBE. Residents were hesitant to assume such a role due to lack of familiarity and perceived benefit. This discrepancy indicates attention should be devoted to: 1) institutional administrative/educational supports, 2) faculty development around feedback/assessment and 3) resident engagement to foster ownership of their learning and familiarity with CBE., Background/Purpose: Competency based medical education (CBME) is becoming the norm in postgraduate and clerkship education. To support this transition in clerkship, we identified an opportunity in our pre-clerkship Clinical Integration courses for initial introduction of a competency-based educational model. Summary of the Innovation: Clinical Integration is a set of courses over the first two years of medical school. The focus within these courses is on clinical reasoning, integration of clinical information, ethic-legal reasoning and information literacy. These skills lend themselves well to a competency-based teaching, learning and assessment model. In this report, we describe the processes used to develop this targeted curriculum including competency identification, competency levels/definitions, assessment, and evaluation strategies. Student focus groups, faculty consultation and review of existing literature were all employed in this iterative process. Implementation of CBME has required close collaboration between the course development team and information technology, assessment, and administrative faculty/staff. Conclusion: This multistep iterative process has been successful in the development of a pre-clerkship competency-based curriculum. Students, faculty and staff have shown enthusiasm for implementing these changes. Both expected and unexpected challenges required attention during the development stages and inaugural implementation., Background/Purpose: Royal College Emergency Medicine (EM) trainees at the University of Ottawa participate in weekly Academic Full Days (AFD) that consist of didactic activities, simulation-based learning, and core content sessions referred to as Core Rounds (CR). Despite CR being intentioned for all EM trainees, an attendance attrition has been noted as trainees progress towards their senior (SR) years (PGY3-5). The objectives of this study were to (1) identify barriers to SR trainee CR attendance and (2) identify areas for CR improvement . Methods: An on-line survey was administered to SR EM trainees (PGY3-5, n = 28) and recent graduates from our program (practice year 1-2, n = 20) to explore perceptions of the value of AFDs, CR attendance barriers, and areas for CR improvement. The survey consisted of 5-point Likert scales and free-text responses. Quantitative responses were analyzed using Microsoft Excel. Free-text responses were analyzed qualitatively using thematic analysis. Each free-text response was reviewed independently by two investigators (JML, MCL) and underwent line-by-line coding. Through joint discussions, the codes from each response were synthesized and themes were identified. Results: Of the 48 trainees and attendings surveyed, 32 responded (response rate 67%). Most respondents (90%) stated they benefited from SR trainee attendance when they were at a junior (JR) level. The majority perceived they benefited less from CR as a SR trainee compared to when they were a JR trainee (85%). Further, 87% responded that CR were not tailored to a SR level, and that they would attend more frequently if sessions were geared to their level (81%). From our thematic analysis, three themes emerged relating to SR trainee absenteeism: 1) CR quality, 2) External Factors (eg. trainee fatigue) and 3) Misalignment with trainees' own education plan. We also identified three themes relating to areas for CR improvement: 1) CR content, 2) CR format and 3) SR trainee involvement. Conclusion: Respondents indicated a benefit to having SR trainee presence at CR. This study identified barriers to SR resident attendance at CR and areas for improvement. With the transition to competency based medical education it is critical that trainees engage in effective educational experiences, especially as the RCPSC does not mandate AFDs for EM training in this new curriculum. A culture-change initiative and CR reformat is now underway at our institution with planned post-implementation analysis., Background/Purpose: Competency frameworks serve many roles including outlining characteristics of a competent workforce, facilitating professional mobility, and structuring curriculum and assessment. Given their significance in health professions, we sought to understand the strategies used in the development of existing competency frameworks. Methods: We conducted a scoping review using the Arksey and O'Malley framework. Six electronic databases and three grey literature sources were searched using keywords related to competency frameworks. Studies of all types were included that described the development of a competency framework in a healthcare profession. Studies were screened for inclusion independently by two reviewers. Data synthesis was both quantitative and qualitative. Results: 190 citations were selected for analysis. The majority of studies were conducted in medicine and nursing. We found a significant degree of diversity in methodological strategies, and inconsistent adherence to existing (albeit limited) guidance on framework development. Based on the variation we observed in choice, sequence, application and reporting of methods and strategies, there is no apparent standardised approach to competency framework development Conclusion: Significant variation exists in the processes used to develop competency frameworks. Adherence to existing guidelines is inconsistent. This raises questions about which processes are fit for purpose and whether resulting competency frameworks capture the complexities associated with clinical practice, the value or completed frameworks to the corresponding profession, and whether existing processes lead to unintended but legitimized artificial outcomes. Guidance in competency development processes may need to be revisited, Background/Purpose: Formal program evaluation is a critical tool for quality improvement (QI) in Canadian medical school curricula and CACMS accreditation requirements. Our school recently underwent curriculum renewal to a competency-based medical education (CBME) model in our undergraduate medical education (UME) program, which created the need for updated program evaluation that accommodates student feedback with UME central evaluation. We identified challenges in the redundancy and volume of evaluation surveys which resulted in student survey fatigue, lower response rates and less meaningful data. Although there is literature on curricular evaluation methods, there was sparse guidance on how to balance student feedback with central evaluation. Our initiative may be of interest to those implementing an evaluation approach which is collaborative between students & UME. Summary of the Innovation: Our former course evaluation consisted of two parallel processes: formal evaluations through UME, and independent student-run evaluations which were not validated for central course evaluations. We merged the parallel streams into a central process with UME and student academic leads collaborating on evaluation instrument development, data analysis, and sharing of data with course leads and UME committees. Conclusion: As part of our commitment to innovative education and the new CBME program, we designed a collaborative program evaluation process to meet the demands of UME central program evaluation while incorporating student involvement. This resulted in fewer evaluation forms for distribution, streamlined the evaluation process, and allowed for collaboration between central UME & students., Background/Purpose: “Retrieval” allows to recover/access stored knowledge: it improves the learning. “Active retrieval” allows to retrieve knowledge through activities like answering questions, writing/talking about the new knowledge, trying to recall through discussions, etc. This method has not been studied in the surgical education setting. The purpose of this study was to evaluate if “active retrieval” through writing can improve procedural learning for simple fracture fixation versus “passive learning” only from reading. We believe active retrieval can improve long term retention of surgical skills. Methods: In this pilot study, we randomized 50 pre-clerkship students to two groups: passive learning group or active retrieval group. All participants watched a video of an open reduction internal fixation with lag screw and plate/screws on Sawbones™. Participants then performed the procedure under guided supervision. Next, they had 15 minutes to either read the steps (passive learning), or write down the steps from memory (active retrieval group). After a 5-minute washout period, participants performed again the procedure without any guidance (immediate assessment). Participants were brought a week later to perform the procedure without guidance (delayed assessment). Each performance was video-recorded for data analysis purposes. Results: Both groups were similar in participants' age or gender. Participants in the passive learning group performed better at the immediate assessment phase. Participants in the active retrieval group performed better in the delayed assessment. There was a decrease in retention between the immediate assessment and delayed assessment for both groups. Conclusion: Active retrieval appears to enhance long term retention of procedural learning., Background/Purpose: Assessment plays a central role in CBME. The operating room (OR) is a demanding environment with competing priorities placed on the primary surgeon, including the assessment of resident's performance. Previous studies show that assessment reliability decreases with increased task complexity. The objective of this study was to explore the utility of video-based assessment of resident performance in the OR. Methods: 5 surgery cases performed by residents under staff surgeon guidance were captured on video using a 3-camera setup: the surgeon's view; the endoscopic view; and a 360-degree view of the OR. Following the case, the in-room staff surgeon assessed the resident using the 11-item entrustment-based O-SCORE, and evaluated his or her own cognitive load during the case using the Surgical Task Load Index (SURG-TLX). Two independent staff surgeons later independently rated the videos to compare to the case surgeon. A post-assessment survey and interview were conducted with the case surgeon, resident & video raters. Results: The interrater reliability between video assessors was high (k=0.82) and mean O-Scores ratings between intraoperative and video assessors O-Score agreement were also high (r=0.7). O-SCORE domains for intraoperative performance had high agreement between the intraoperative assessment and video-based assessment (r=0.68). All assessors expressed low cognitive load during viewing or while scrubbed into the case with mean SURG-TLX scores of 5 (SD ±1.8). Video-based reviewers frequently rewound the video during critical steps of each case to assess resident performance. Conclusion: This study showed that video-based assessment of resident performance during surgery using the O-SCORE is useful and feasible, with high interrater reliability among the case surgeon and independent video reviewers. Use of the SURG-TLX also provided new insight into the cognitive load of both case surgeons and video reviewers., Background/Purpose: Resident duty hours (RDH) have emerged as a controversial topic in medicine, particularly given the introduction of night-float (NF) systems. However, limited evidence exists investigating the impact of RDH on well-being. We conducted a systematic review to better understand the effects of RDH on wellness among resident physicians in Canada. Methods: A systematic review of duty hours on resident physician wellness in Canada was conducted using the PubMed, MEDLINE, and CENTRAL databases from 1989 to 2019. Literature screening and data extraction were independently conducted by two reviewers. Sub-analyses of the effects of RDH on wellness based on specialty and NF models were then performed. An explorative analysis was subsequently completed to identify themes related to resident perceptions of wellness based on duty hours. Results: After screening 261 articles, a total of 14 articles met inclusion criteria. Nine articles (64.3%) found a positive association between fewer RDH and improved wellness, while 3 (21.4%) found no change, and 2 (14.3%) found a decrease in wellness. Sub-group analysis of NF systems (n=9) demonstrated a positive impact on wellness in 6 articles (66.7%), no difference in 2 (22.2%), and a negative impact in 1 (11.1%). Sub-group analysis of specialty demonstrated a positive impact of fewer RDH on wellness among surgical residents in 71.4% of studies. Several themes emerged impacting residents perceptions of RDH on wellness, including: 1) flexibility in scheduling; 2) maximizing educational opportunities; and 3) changes in team dynamics. Conclusion: Overall, RDH reforms improved resident well-being, however this relationship is complex. Further research is necessary to characterize the effects of factors such as specialty and system design on resident wellness., Background/Purpose: The prevalence of burnout, depression, and anxiety amongst medical trainees is worryingly high, with consequences including reduced learner productivity, poorer quality of care, increased medical errors, and decreased empathy. Interventions that have been shown to mitigate these effects have often included some form of reflective practice, although none have emphasized the role of professional identity formation, a process which is increasingly recognized as critical to the maintenance of wellness. To address this gap, a novel curriculum was designed to support Family Medicine resident wellness through reflection on professional identity. Summary of the Innovation: All Family Medicine residents (total 50) at two academic Family Medicine Teaching Units at the University of Toronto participated. Four faculty members were recruited to facilitate. The curriculum included eight 2-hour reflection sessions occurring periodically through the two-year residency. Residents were divided into small groups of approximately 12, based on residency year and training site. Sessions were facilitated by faculty members from the alternate site. Qualitative data was collected through post-session feedback forms (administered after each session), as well as through resident and faculty focus groups (which probed for more general impressions at the end of the academic year). Conclusion: Thematic analysis demonstrated that a longitudinal curriculum encouraging reflection on professional identity is highly valued. Additional findings regarding the importance of “protecting” the discussions, facilitator skillset, and the role of individual personality will be used to guide the curriculum's future iterations., Background/Purpose: The prevalence of burnout raises many concerns with regards to organizational culture and patient safety. Difficult clinical events during medical school (e.g., patient death, moral distress) may negatively impact resiliency and well-being among medical students. Previous studies suggest that resiliency training surrounding stressful clinical events during medical school may alleviate the potential impact of these encounters (Houpy et al, 2017) Methods: To prepare current and future health professionals in mindfulness-based stress management tactics, the Simulated Training for Resilience in Various Environments (STRIVE) program was developed to train medical learners about the Mental Health Continuum, the Big Four +, and to provide a safe, non-judgemental learning environment to practice these skills in realistic, simulated clinical scenarios. A longitudinal design examined the impact of STRIVE tactics on medical students following the initial pilot in Summer 2018. Results: Increases in participant's confidence to identify early signs of burnout, support peers, find resources, and teach peers about resiliency techniques increased post-STRIVE (16.9 +/- 1.71) and were sustained 6-months following the program (14.87 +/- 2.07) [F(2,97) = 23.964, p = 0.000]. Mean increases on the CD-RISC following STRIVE (15.9 +/- 2.09) as well as 6-months later (15.8 +/- 2.19) were not statistically significant [F(2,97) = 1.082, p = 0.343]. Conclusion: Mindfulness-based stress management tactics may be beneficial for medical students to learn to promote student confidence and skills in identifying signs of burnout, support peers, find resources, and teach others. Future research on how to sustain improvements in self-reported resiliency in medical education is warranted., Background/Purpose: Physician burnout has been acknowledged as an issue of increasing importance. To combat burnout, the promotion of physician well-being has previously focused on individual interventions, however, increasing emphasis is being placed on cultural changes in medical education and the health care system. The relationship between language and culture has been well described in literature for other fields of study, including anthropology, philosophy, linguistics and psychology. The purpose of this project was to determine the impact of language in promoting a culture of wellness. To our knowledge, this is the first innovation directed at harnessing positive language at multiple levels of medical training in order to systemically promote physician well-being. Summary of the Innovation: A pro-wellness language task force was created by Resident Doctors of Canada, with representation from multiple subspecialties including internal medicine, pathology, and psychiatry. A literature search was conducted looking for evidence on the use of language to promote cultural change in medicine and other professions including nursing and business. Through an iterative process, themes were derived on words & phrases that promoted wellness, or 'pro-wellness' language: (1) validation of stressful situations (2) creating a sense of solidarity and (3) supporting peers in their pursuits for wellness. Two infographics were created to disseminate these themes. These infographics will be shared with medical trainees to promote reflection on the impact of language on promoting wellness in daily conversation. Conclusion: Language has a strong impact on shaping culture in medicine through validation, creating solidarity and support among physicians. Further dissemination of 'pro-wellness' language is important for medical trainees, residents and supervising physicians in order to promote a culture of wellness., Background/Purpose: Few data are currently available on the non-medical use of prescription psychostimulants in Quebec among medical students. The FMEQ has therefore examined the situation to better understand this issue that affects many of its members. Methods: An optional survey was distributed in the fall of 2018 to medical students in Quebec through local student associations and the FMEQ, particularly through e-mails and social networks. Results: In total, the survey collected 884 responses, representing 21% of the medical student population in Quebec. 71% of respondents self identified as women, 28% as males and 6% of participants reported having a diagnosis of ADHD. 8% of respondents reported having used psychostimulants for non-medical purposes. Also, ⅓ respondents have already considered using psychostimulants during their undergraded medical studies without having done so. Conclusion: The survey results reveal that the proportion of medical students in Quebec who have used psychostimulants for non-medical purposes (8%) is above the average of the general student population in Canada (4.5%), but below the use of American medical students (10.1%). The survey also reveals that the majority of students who take non-prescribed stimulants do not do so with a purely competitive aim; curiosity, delay and self-medication being equally prevalent. Awareness campaigns including side effects would be beneficial for this student population to prevent abuses., Background/Purpose: Committed to promoting wellness within University of Toronto's MD program, Student Health Initiatives and Education (SHINE) organizes a range of events for academic development, career exploration, and resilient self-care. In collaboration with the Office of Health Professions Student Affairs (OHPSA), we aim to design opportunities that can best support mental health throughout medical training. This vision necessitates evaluation of experiences with wellness initiatives and exploration of concerns, barriers, and facilitators for student engagement. Methods: A survey invited students to share reasons for or against engaging with the events and services offered by SHINE and OHPSA, thoughts on whether and how such programs contribute to their well-being, and ideas for alternative supports. Results: Thematic analysis of survey responses (n=69) revealed a prevailing positive attitude towards student-run wellness initiatives. In particular, the events with the highest attendance and engagement focused on relieving stress with a sense of solidarity and fostering dialogue on the challenges of work-life balance in medicine. Perceived facilitators to greater participation emphasized convenience, namely with regards to location and time. Interestingly, the latter was reiterated as a key concern for OHPSA's programs, with scheduling difficulties considered the predominant barrier to seeking professional services. Accordingly, the survey respondents advocated for strengthening SHINE's collaboration with faculty, such that both student- and staff-led supports become more accessible. Conclusion: Receptivity to wellness initiatives is dependent on their ability to address student concerns. By collecting and incorporating feedback, peer-run and faculty-led groups can develop accessible opportunities tailored to medical students' needs, thereby strengthening their engagement and well-being., Background/Purpose: The learning environment in medical school is an important consideration for student motivation and wellbeing. The purpose of this work is threefold: a) to explore how student mindfulness and resilience predict changes in their perceived stress and coping; b) to assess how this relationship might change, accounting for students' perceptions of the supportiveness of their learning environment to their basic needs of autonomy, competence, and relatedness; and c) to assess whether perceived stress and coping vary by gender and year of study. Methods: The authors conducted an online survey at the University of Saskatchewan, measuring student mindfulness and resilience, perceived stress, coping, and perceived need satisfaction/frustration. Hierarchical regression assessed how gender, year, mindfulness, and resilience predicted changes in perceived stress and coping, accounting last for students' perceived need support. Results: 197/400 (49%) students were evaluated: 92 males (47%), 105 females (53%) - 71 (36%) 1st years, 58 (29%) 2nd years, 36 (18%) 3rd and 4th years. Higher mindfulness, resilience, and perceived need satisfaction predicted lower perceived stress, more adaptive, and less maladaptive coping. When students perceived their learning environment as need-frustrating, it predicted the opposite effect, and neither mindfulness nor resilience suppressed maladaptive coping. Third years reported the highest stress and use of denial. Females reported coping with more instrumental and emotional support and behavioural disengagement. Conclusion: Mindfulness and resilience may be beneficial to medical student stress and coping; however, their wellness benefits likely depend on motivational factors within the learning environment (i.e. how supported students feel their basic needs are)., Background/Purpose: Physician residents' well-being is a persistent yet evolving challenge. Difficult learning environments often result in psychological distress and can lead to mental illness. According to a recent survey conducted by the “Fédération Médicale des Résidents du Québec” (FMRQ) based on the Maslach Burnout Inventory (MBI), 55% of residents were suffering of burnout. Furthermore, 27 % of residents admitted having suicidal thoughts at least once during their lifetime in a study performed by the Canadian Medical Association (CMA) in October 2018. Despite available resources, most residents remain unaware of their existence or are reluctant to consult them. Summary of the Innovation: To address this important issue, we created a program called Sentinel Resident. The main objective consists of on site, peer-led support through careful listening and referral to adequate resources. During our pilot project, 20 residents among 9 medical and surgical specialities were selected by their peers or volunteered to assume these responsibilities. They are currently distributed in 10 different training sites. Residents received small-group training with Quebec Physician Health Program' instructors. A simulation and feedback approach was used to learn how to recognize and help colleagues in distress. A guide was also created to assist sentinel residents. It includes references for different problematics: financial, parental difficulties, harassment, substance addiction etc. Conclusion: This program aims to rapidly identify and help residents in emotional need by providing on site peer support. The ultimate goal is to improve their well-being by ensuring a supportive, non-judgmental climate and rapid redirection to the right resources in time of need., Background/Purpose: Harassment has been well-documented in medical training and the physician workplace; current best practices for reporting are described (1-5). Despite increasing recognition of its burden, little has been reported about the available mechanisms for reporting harassment for physicians and trainees. We performed an environmental scan of harassment reporting mechanisms for medical students, residents, and physicians working in Calgary, Alberta in order to: (1) produce a guide that medical professionals and trainees can utilize if they experience harassment in the workplace, and (2) identify potential limitations or gaps in harassment reporting mechanisms that create barriers to reporting. Methods: A list of reporting mechanisms was created through a detailed internet search of publicly available mechanisms and snowball sampling. A standardized data collection template was created based on known best practices for harassment reporting (5). Each organization was contacted by email or telephone and interviewed using the standardized data collection template during August 2019. Results: We gathered valuable insights regarding the complexity and lack of transparency and communication between reporting mechanisms in Calgary. The numerous organizations to which medical professionals and trainees may file harassment reports in Calgary creates a lack of direction for individuals. Second, many reporting mechanisms refer individuals to other agencies, rather than pursuing direct involvement. Lastly, lack of communication between reporting policies raises the possibility of multiple reports against the same individual without identifying repeat offenders. Conclusion: This research identifies a need for a single regulated domain to which all reports can be filed and reviewed to adequately address physician and learner harassment., Background/Purpose: “BEEP-BEEP SIM” prepares medical students to be paged for on-call situations. It combines escape game elements and low-fidelity simulation to achieve learning for tailored objectives, drawing on teaching strategies of gamification and repetition, and enhancing motivation through the self-determination theory (through an experience that promotes competence, autonomy, and relatedness). Summary of the Innovation: 5 teams of 3-5 students (n=20) piloted “BEEP-BEEP SIM”. Teams completed 6 “rooms” in any order. Each room contained 4 puzzles regarding on-call clinical topics. If teams exceeded 10-minutes for a room, a facilitator assisted. Solving 4 puzzles enabled unlocking of a room's box. Each box contained a summary card of teaching points for that room, which students reviewed. Once 6 rooms were completed, students were debriefed; this included a verbal quiz to promote retrieval of learned content and an instructor-facilitated summary to reiterate learning points. The average learner-reported confidence (n=20) in learning objectives for Hyperkalemia (2.24/5.00 to 4.02/5.00), Chest Pain (3.46/5.00 to 4.46/5.00), Hyperglycemia (2.86/5.00 to 3.98/5.00), Agitation (2.39/5.00 to 4.34/5.00), Fall (2.81/5.00 to 4.14/5.00), and Fever (2.81/5.00 to 3.96/5.00) increased pre- vs post-session (all p, Background/Purpose: Digital rectal examination (DRE) is an inherently difficult examination to teach due to its unsighted, tactile, and intimate nature. Tutors often have difficultly explaining and providing specific feedback for internal steps. Surveys of medical students reveal a lack of confidence and training in performing DRE. We propose and attempt to validate the use of novel simulation-based tools for teaching DRE. Summary of the Innovation: 20 medical students were randomly allocated into 3 study arms: Control, See-through (ST) and See-through with Anatomy (STwA). Control arm were taught how to perform DRE with traditional methods, via a traditional benchtop model. For ST and STwA arms, position and pressure sensors on the examining finger allowed temporal, spatial, and pressure mapping on benchtop models in addition to visualisation of subjects' dynamic real-time performance on a computer simulated 'see-through' model. For STwA arm additional overlayed surrounding anatomy was illustrated. Qualitative evaluation of DRE learning experience was measured. Conclusion: There were statistically significant differences between arms on feedback regarding learning [F(2,17)=11.64, p=0.001]. Post hoc test indicated statistically significant higher mean 5-point Likert scores for both ST (4.29±0.49) and STwA (4.48±0.26) arms, compared to control (3.22±0.69). 100% of ST and STwA arm agreed that 'seeing through' helped them understand DRE better than the standard benchtop model. We propose that these high-fidelity See-through tools are impactful vehicles for the dissemination of modern DRE education for medical students and healthcare professionals internationally, and these concepts should be explored for further application in alternative intimate examinations., Background/Purpose: Is there a healthcare provider on board? Healthcare providers may be less confident for in-flight medical emergencies, as these situations are not part of their training curriculum or usual practice contexts (e.g. hospitals). A crowdsourcing session and simulation to mentally rehearse and practice clinical skills in airplane settings may improve their emergency preparedness. Summary of the Innovation: This innovation involved: i) a session to crowdsource insights from multidisciplinary healthcare and first aid providers, followed by reviewing considerations of a CMAJ 2018 article on airplane emergencies, and ii) 2 airplane simulations (syncope and cardiac arrest). During crowdsourcing, 7 learning objectives of in-flight medical emergencies were explored: i) challenges, ii) solutions, iii) equipment, iv) taking vitals, v) general approach, vi) cardiac arrest approach, and vii) human resources / role-delegation. Knowledge and approaches extracted were then applied in simulations. Participants provided scores out of 7.00 for: i) satisfaction of crowdsourcing session and simulation and ii) self-rated confidence on learning objectives at baseline, post-crowdsourcing session, and post-simulation. Results were analyzed with repeated measures ANOVA with post-hoc Tukey. Participants rated the crowdsourcing activity (6.70/7.00, n=11) and simulation (6.50/7.00, n=11) positively. Self-rated confidence in the 7 topics improved from baseline (2.49/7.00) to post-crowdsourcing (5.23/7.00) to post-simulation (5.94/7.00), with significant differences (p, Background/Purpose: Technological innovations have facilitated the introduction of case-based learning through virtual patient (VP) simulators into medical education. Current VP simulators usually consist of linear patient cases and multiple-choice questions, which limits the fidelity and educational potential of these simulations. We attempted to address these limitations by integrating natural language interaction and building branching cases with ample opportunity for the trainees to explore various outcomes related to their clinical decisions. Our learning tool provides trainees with a safe pseudo-clinical opportunity to perform in a leadership role. This type of innovation is sparsely mentioned in the literature. As so, our VP simulator will present a novel learning tool for neurosurgical trainees. Summary of the Innovation: Two multifaceted neurosurgical cases (traumatic subdural hematoma and paediatric cerebral neoplasm) were created, reviewed, and integrated into a case exploration platform. Cases were chosen for their complexity, allowing for multiple key decision points. Each case entails trainees entering real-text commands to gather pertinent information, perform physical exams, order tests, interpret results, and make treatment decisions. Cases have multiple patient outcomes dependent on the trainee's clinical decision making. Educational documents at the end of each case serve to address any trainee knowledge deficits or reasoning errors. Conclusion: Our case-based VP simulator provides neurosurgical trainees with a safe and structured oral exam style opportunity to practice and improve upon their clinical approach to standard neurosurgical patient presentations. This is a novel modality, not currently available or previously published in neurosurgical literature, that could be expanded for use in other fields., Background/Purpose: Under the present conditions of the Quebec healthcare system, the majority of physicians will practice in a community clinic. Furthermore, according to Pearl & Fogel, “graduating students still lack the fundamental business and leadership training needed to […] maximize quality and reduce cost in clinical practice,” (NEJM, 2016). Considering this, we created a simulation activity for medical students and residents to learn the key stages in the drafting of a business plan for a medical clinic. This is the first simulation that aims at teaching an understanding of the complex nature of establishing a community clinic in Quebec. During the 2019 edition, we used a focus group and validated questionnaire to evaluate whether participation may have an impact on the understanding of administrative aspects of medical careers, on student and resident attitudes towards clinic development, and ultimately inspiring strong physician leadership with the goal of maximizing quality of care. Methods: Participants were provided a guidebook with specific instructions and theoretical notions pertaining to each stage of clinic development (from mission and vision to budgeting). The collected data were integrated into the simulation software to assess many parameters including the number of patients seen in their clinic in a year, the type of appointment, and the clinic's expense/revenue ratio. Throughout the simulation, participants had access to professionals to guide their decision-making. Physicians, lawyers, tax experts, notaries and actuaries were assigned to mentor each team. Participants then prepared a five-minute presentation which was evaluated based on the following criteria: creativity, leadership, management skills and efficiency. At the closing of the activity, participants were invited to fill out a questionnaire and participate in a focus group. Results: Out of the 72 participants of the third edition of the MCSC, 55 students responded to the survey (76.4%). Overwhelmingly, respondents perceived (70.9%) healthcare management and administration knowledge as useful for future doctors. However, only 56,4 % of respondents find it essential for medical students to learn how to work in and operate a clinic. The MCSC helped 52 medical students (94,5%) to develop an interest in improving healthcare delivery. Conclusion: Medical student interest in healthcare administration as well as skill-building can be accomplished through the simulation of the creation of a medical clinic. Future studies can evaluate if the skills acquired are transferable to practice and lead to an increase in physician involvement in healthcare management and the implications of this on quality of care., Background/Purpose: We seek to understand if instructions to perform a task faster (“chronometric pressure”) establish the conditions of the speed-accuracy trade-off. Methods: Study design: This is a prospective cohort study of novices performing two-handed knot-tying for simulated vessel ligature. We compare each individual's performance upon verbal instructions to provoke varying chronometric pressure: “no pressure,” “speed emphasis,” “accuracy emphasis,” “maximum speed.” We determined their speed (timed in seconds), integrity of knots (yes/no) and the ratio of the two (=accuracy*100/time). Fitts' Law would predict: for no pressure, a high and variable accuracy ratio; for the speed and accuracy emphasis a consistent but lower ratio; and a yet lower ratio for the maximum speed condition. STUDY PROCEDURE: In a 3 hour session, after instruction and four warmup repetitions, 7 participants did 6 ligatures (36 throws) in each of the four conditions using 2-O Prolene. A SawBones knot tester with 10 pounds of pressure determined if knots held. Results: Time per ligature differed across conditions (p, Background/Purpose: Medical lab technologists (MLT) generally collect blood samples, however, in the absence of these human resources, other health care practitioners (HCPs) have to perform these skills. This is known as phlebotomy. Because of infrequent sample collection, HCPs may be less efficient and subject to pre-analytical errors. Since it is a procedure that falls within the scope of multiple health professions, it becomes prudent to develop and validate versatile, experiential training programs. We have developed a phlebotomy serious game (PSG) designed to train HCP's in the venipuncture process from supply and patient preparation through post-collection documentation. Summary of the Innovation: The current version of the PSG consists of VR modules, hands-on physical models, and XR modules. We compared the PSG's learning objectives against the expected competencies of an entry-level MLT (CSMLS, 2019). Of the 95 expected sub-competencies, the alpha version of the PSG covers 14, and the current beta version can cover up to 93. Results: Current learning objectives within the PSG successful map onto 98% of the sub-competencies as articulated by CSMLS. Additionally, PSG objectives can also be mapped onto the CanMEDS key competencies in the roles of: Communicator, Leader, Health-Advocate, Scholar, Professional, and Medical Expert. Future directions include measuring face, content, and construct validity of the PSG, and longitudinal tests of educational efficacy and effectiveness. We expect the PSG will increase competency in both training and clinical settings, while reducing errors amongst MLTs and other HCPs., Background/Purpose: Despite existing guidelines on ECT curriculum for medical residents, ECT training in Canada is not standardized. HPS-based training compared to traditional training has been shown to be superior in improving clinical skills. Thus, this study evaluated if HPS-based teaching will excel in improving knowledge, skills, confidence and interprofessional collaboration in delivering ECT in an interprofessional (IP) setting compared to traditional setting. Methods: Psychiatry/Anesthesia residents' (n=36) performance in ECT were evaluated in a double-blind randomized control trial. Testing on knowledge, skills, confidence and IP perceptions and collaboration was done utilizing: multiple choice questions, ECT Skills and Knowledge Confidence scale/modified Objective Structured Assessment of Technical Skills (OSATS)-checklist and global rating scale and interdisciplinary education perception scale (IEP)/IP Collaborator Assessment Rubric, respectively. A series of paired- and independent sample t-tests examined the efficacy of HPS-based training. Results: Participants, regardless of intervention type, gained knowledge, confidence and skills after training. Regardless of profession, HPS-exposed groups showed increased level of care of patients during ECT, skin/scalp preparation (OSATs subdomains) and total IEP scores (p, Background/Purpose: La formation interprofessionnnelle (FIP) vise à développer la collaboration interprofessionnelle (CIP) chez les travailleurs de la santé incluant la clarification des rôles. Par contre, le design pédagogique optimal des activités de FIP reste à définir. L'une des initiatives pédagogiques proposées est la simulation de table (TTX). Ainsi, nous avons tenté une FIP innovante avec une TTX ayant pour but d'enseigner un nouveau protocole de code rose intra-hospitalier dans les zones autres que le centre des naissances, la néonatalogie et le bloc opératoire. L'objectif primaire de l'étude est d'évaluer la perception des participants à propos de cette FIP. > Methods: Cette étude est rétrospective. Un groupe interprofessionnel a été recruté. Immédiatement après la TTX, un sondage de satisfaction a été remis aux participants. Des statistiques descriptives (n, %) ont été effectuées. Les commentaires recueillis lors du débreffage ont permis de nuancer les résultats. Results: Treize professionnels ont participé à la TTX. De ces 13 professionnels, 10 ont répondus au sondage (10/13 : 77%). Suite à la TTX, 80% (n=8) des participants ont eu l'impression de mieux comprendre leur propre rôle et 90% (n=9) des participants ont eu l'impression de mieux comprendre le rôle des autres professionnels. Tous ont apprécié la TTX et tous ont affirmés qu'il était probable ou très probable qu'ils participent à nouveau à une telle activité s'ils y étaient invités ou qu'ils recommanderaient à un collègue d'y participer. Conclusion: La TTX a été appréciée par les participants et les apprenants se sentent globalement plus confiants dans leur rôle et dans leur connaissance du rôle des autres professionnels. Le bénéfice de la TTX pour la FIP par rapport à d'autres modalités de simulation reste encore à prouver., Background/Purpose: At St. Michael's Hospital, an interprofessional collaboration competency framework (IPCCF) was developed to improve collaborative competency and support team-based care. This study evaluated whether formally embedding domains from the IPCCF within team simulation-based medical education (SBME) enhanced practitioner competency compared to usual simulation education. Methods: A randomized control trial with concurrent mixed methods was used. Participants were randomized to receive either pre-simulation education (Intervention) or usual SBME pre-briefing (Control). Self-perceived collaborative competency was measured using the Health Professional Collaborative Competency Perception Scale (HPCCPS). Qualitative thematic analysis of debriefing audio-video data was used to explore participant perception of IPC. Results: Intervention and control groups were similar demographically (I: n=28; C: n=25). There were no significant differences in mean change on HPCCPS between groups. In debriefing, intervention groups generated increased dialogue around communication, teamwork and role awareness, and initiated more self-reflection on IPC than control participants. Facilitators frequently adopted a teaching role, which may have inhibited dialogue surrounding IPC. Conclusion: Results suggest that pre-simulation education on IPC competencies did not affect participants' self-reported collaboration. It did lead to greater discourse about IPC, which may result positively in attitudes toward and ability to collaborate. Results may inform future delivery and assessment of SBME intended to enhance IPC competencies., Background/Purpose: Canadians are in the midst of an opioid crisis; a crisis driven in part by prescription opioids. Canada has the second highest rate of opioid prescribing per capita in the world. Within Ontario, the Erie St. Clair Local Health Integration Network (LHIN) is among the highest of 14 in terms of opioid prescribing rates. Given that the Thamesview Family Health Team (TFHT) is within this LHIN, as well as the risks and harms associated with prescription opioids, the present study aimed to evaluate the opioid prescribing practices of the TFHT. Methods: Opioid prescribing practices were evaluated based on the 2017 Canadian Opioid Prescribing Guideline. Using Practice Solutions Suite, we identified all patients within the TFHT who had an active opioid prescription from June 2018-June 2019. We then used the Opioid Toolbar to calculate the morphine equivalent (MEQ) for each patient. Lastly, we interviewed 17 physicians regarding their patients with an MEQ >= 90, their approach to managing patients with chronic non-cancer pain (CNCP), and their attitudes toward the guideline. Results: Five percent of rostered patients had an active opioid prescription. Of these patients, 10% had an MEQ >= 90. Physician's approaches to managing patients with CNCP and those with an MEQ >= 90 were multimodal. Most physicians supported the guideline but found it unrealistic in certain situations. Six physicians began implementing the Opioid Toolbar. Conclusion: Physicians of the TFHT are implementing the 2017 guideline into their practices. Furthermore, the Opioid Toolbar provided an effective way of evaluating opioid prescribing practices., Background/Purpose: The system medical (MD) students feel the least confident about when graduating is the musculoskeletal (MSK) system. In comparison, physiotherapy (PT) programs dedicate an extensive amount of time on the MSK exam. This premise led a group of medical students to create a series of interprofessional (IP) MSK hands-on workshops where PT students collaborate with MD students to review anatomy and practice the MSK exam. The objective of this study is to determine whether participation in peer-learning IP workshops increases knowledge and confidence of MD students regarding MSK exam. Methods: McGill University MD students (N=9) attended 3 workshops on a voluntary basis, each covering a different joint. Pre-post workshop knowledge quizzes and confidence questionnaires were used to assess short-term (immediate) and long-term (6 months) change in knowledge and confidence level related to the MSK exam. A focus group interview (N=4) was conducted to gain an in-depth understanding of MD students' perspectives about the workshops. Results: Results show a significant increase in knowledge quiz scores post-workshops (mean: +2.4, p=0,013) with immediate increase of 25% and long-term increase of 13%. At baseline, 7/9 (78%) participants identified as not confident in performing an MSK exam, 0 participant identified as such post-workshops. Qualitative reports show MD students highly value this learning environment, find hands-on learning activities lacking in MD curricula and IP learning allows for realistic contexts which reinforces knowledge acquisition. Conclusion: Student-led IP MSK workshops have been effective in advancing knowledge and increasing confidence regarding assessment of the MSK system, representing a promising avenue for medical education curricula., Background/Purpose: The patient's experience of their illness is an important consideration in providing effective and compassionate health care. The Patient and Family Narratives (PFN) seminars at the University of Saskatchewan were created to provide a venue for health professions students to experience stories of patient journeys through illness and treatment. Since 2010, these 90-minute PFN sessions have provided up to 500 student experiences each year. During each PFN session, a patient, often accompanied by a family member, takes 30-40 minutes to share parts of their personal illness story and select encounters with health care providers. In small interprofessional groups, students discuss relevant questions. Methods: We analyzed hundreds of student comments collected over the last few years. We then developed a survey and sent it to the 196 PFN student attendees in 2018-2019. The survey asked participants to rate features of the PFN utilizing a 6-point scale from “strongly dissatisfied” to “strongly satisfied”. The Behavioral Research Ethics Board of the University of Saskatchewan granted an exemption from ethics review since this study was designated a program evaluation. Results: Fifty students (response rate of 25.1%) completed our survey representing over 150 individual student experiences. Students rated highly the PFN seminars overall and the patient stories alone: means of 4.3 and 4.9 respectively. Students rated the small group discussions at 3.3. Conclusion: We believe that the PFN seminars have contributed to the education of health professions students by connecting them with patients and their stories. We will offer PFN sessions in 2019-2020 but will improve the structure of the small interprofessional groups., Background/Purpose: Simulation is the virtual, physical, or hybrid replication of a task/event for the purpose of training and assessment and must be contextually accurate to be functional. Therefore, a single profession does not suffice when designing simulation experiences, but instead several professions must work together. To address this, we have developed maxSIMhealth (MSH). Summary of the Innovation: MSH is a multidisciplinary collaborative of manufacturing, design, and simulation labs at Ontario Tech University combining expertise in Health Sciences, Business and IT, Engineering, and more while building community partnerships to advance simulation training. MHS' vision is to advance knowledge discovery and application that revolutionizes health by offering innovative solutions for simulation training and clinical application. It discovers existing simulation gaps, provides innovative solutions that change systems, and leads to improved healthcare outcomes. Specifically, we utilize disruptive technologies (3D printing, gaming, extended reality) as innovative solutions that deliver cost-effective, portable, and realistic simulation, which is currently lacking. Our work spans a broad spectrum of scholarship from mapping existing gaps, to changing education systems, to improving learning and performance outcomes. To ensure timely and meaningful knowledge translation, we have established an institutional channel within the Cureus Journal for Medical Sciences where our work is freely disseminated as peer-reviewed, PubMed-indexed publications. Conclusion: MSH is a novel collaborative innovation with aims to develop future cohorts of scholars with strong competencies ranging from technology application, to collaborating in new environments, to communicating professionally and problem-solving. Our work will transform the current health professional education landscape by providing novel, flexible, and inexpensive simulation experiences., Background/Purpose: Biological threats, such as B. anthracis in 2001, SARS in 2003, H1N1 in 2009, Ebola in 2014, and Zika in 2016, challenge international health security. In 2003, the Association of American Medical Colleges (AAMC) recommended incorporating a biosecurity curriculum into undergraduate medical education. While previous curricula focused on structured responses, we introduce an established curriculum that includes didactics and problem-based learning to teach students innovative solutions to biothreats and bioterrorism. Summary of the Innovation: First introduced in 2010, Introduction to Biosecurity and Bioterrorism is a ten-week course taught biweekly within the School of Medicine at Stanford University. Designed to reflect the dynamic and interdisciplinary field of biosecurity, the course constructs a foundation of knowledge with face-to-face didactics from national biosecurity experts. The co-construction of knowledge from students across medicine, engineering and technology development, public health and policy, allow for an interprofessional approach and appreciation of biosecurity threats. Our instructional methods include: core readings, active engagement with experts during didactic lectures, participation in group discussions, and completion of a small group innovation solutions project. Conclusion: Medical schools have struggled to incorporate biosecurity topics into traditional models of undergraduate medical education. This curriculum highlights an established biosecurity curriculum that integrates didactics and problem-based learning to prepare students for future roles in biosecurity., Background/Purpose: On-call duty at Cardiology Intensive Care Units (CICU) is challenging for junior residents especially during night shifts, as they manage ill patients, while advice from senior residents is only available via telephone. Nurses with many years of experience play a substantial role in teaching junior residents medical procedures. A review of the literature reports that nursing contributions to medical education during on-call duty are poorly acknowledged and represent an untapped potential. Summary of the Innovation: The CICU at the Centre hospitalier universitaire de Montréal is a non-surgical twenty beds department staffed by junior residents during night shifts. To date, no formal documentation has been available to support them. A twenty page toolkit was created by second year residents in collaboration with nurses cumulating each more than ten years of experience. The aim was to assess expectations of both junior residents and nurses. The toolkit is a guide for the management of common cardiac pathologies and complications and is not meant to replace official guidelines. One chapter aspires to fulfil gaps in knowledge about hospital protocols and clinical procedures identified by nurses. The toolkit was approved by the CICU Medical Director and is now used by forty junior residents. Satisfaction assessment shows that new junior residents felt more confident after reading it. Conclusion: In the era of multidisciplinary health care teams, sharing knowledge across disciplines is of cardinal importance. The toolkit formally recognised the necessary collaboration between on-call duty medical residents and nurses and provides a tangible support for new junior residents., Background/Purpose: There is growing evidence demonstrating that increased exposure to LGBTQ health content in medical school curriculum increases student knowledge about LGBTQ health, improves the performance of medical learners in the delivery of health care services to LGBTQ patients, reduces stigma from medical learners towards LGBTQ patients, and increases medical learners' willingness to treat LGBTQ patients in their future practice (Kelly et al, 2008; Sanchez, et al, 2006; Strong, 2013). In 2015, the University of Toronto developed and launched a new integrated Foundations Curriculum on LGBTQ health. The purpose of this study was to evaluate this new curriculum and assess its' impact on student's knowledge of LGBTQ health and comfort level working with LGBTQ populations. Methods: First year medical students who had not yet received the LGBTQ Foundations curriculum and second year medical students who had completed the curriculum were asked to complete an anonymous and confidential survey evaluation via email. This survey included the Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT-DOCSS), a newly validated 15-item-scale designed for interdisciplinary clinical assessment of health providers (Bidell, 2017). Results: A total of 73 medical students completed the survey. The LGBT-DOCSS scale is analyzed as a total scale, as well as three independent sub-scales: knowledge, clinical preparedness and attitudes. All scores are calculated out of 7. The LGBT-DOCSS total score among first year medical students was 4.9, vs 5.7 in second year students, a difference of 11.4 % (p, Background/Purpose: In response to the Truth and Reconciliation Commission Report and its Calls to Action, Women's College Hospital (WCH) is currently working towards developing and implementing strategies to help transform the institution to become a safe and more inclusive space for Indigenous Peoples. One key step towards this goal is the development of an Indigenized evaluation model/framework to better understand institutional transformation to ensure that the initiatives/programs implemented best meet the needs of Indigenous Peoples. Summary of the Innovation: In an effort to address the limits of using Western forms of evaluation we are engaging in a process of working to decolonize the evaluation practices of indigenous services at WCH. To do so, we are using the 'Wise Practices” guidelines to ensure that Indigenous knowledges and perspectives are acknowledged, captured and included when evaluating the institutional transformation that WCH is going through to create safer and more inclusive health care for Indigenous Peoples. Decolonizing evaluation is a complex, multi-layered and ongoing process. The Wise Practice approach highlights that there is no one size fits all and also challenges the 'best' practices model by commanding a critical awareness of who and how it is decided which practices are best as well and who they are best for. Conclusion: Working towards decolonizing evaluation requires a critical look at Western colonial forms of evaluation and evaluative markers while simultaneously trying to decolonize one's own perspective and which knowledges/perspectives are valued over others, Background/Purpose: The Association of Faculties of Medicine of Canada (AFMC) has a long-term commitment to promoting social accountability (SA) and indigenous health. The Faculté de médecine de l'Université de Montréal intends to contribute to this commitment by implementing a major partnership project that targets and involves the indigenous populations it is mandated to serve. Summary of the Innovation: The project is the result of a collaborative partnership between the Faculty's SA office and the Regroupement des centres d'amitié autochtones du Québec (RCAAQ): it aims to better understand the specific health training needs of indigenous populations, particularly in identifying issues related to its accessibility and relevance, co-constructing a concerted action plan and monitoring its implementation. Our second goal is to educate our students and our colleagues teaching in health sciences about Indigenous realities and their culture. The priority populations targeted in this project are urban Indigenous communities of La Tuque and Trois-Rivières. Three citizen forums were organized between March and May 2019: Two local forums and a regional forum attended by 62 participants including 40 indigenous made it possible to identify issues and courses of action. Five areas of work have been identified to structure our action plan. Conclusion: This public consultation process has established a relationship of trust with the Indigenous community and co-constructed this academic project together. This approach will serve as a model for future planned projects with other vulnerable populations served by our faculty., Background/Purpose: Including curricula on Indigenous health in medical school is an acknowledged prerequisite for reducing Indigenous health disparities in Canada. However, little is known about medical students' knowledge and interest in Indigenous health at entry to medical school, and it is unclear whether current Indigenous health curricula successfully impacts their beliefs and behaviours. Methods: Students (n=129) at one Canadian medical school completed a survey that evaluated their sociopolitical attitudes towards Indigenous people, knowledge of colonization and its links to Indigenous health inequities, knowledge of Indigenous health inequities, and self-rated educational preparedness to work with Indigenous patients. Students' perceived importance of learning about Indigenous peoples, and interest in working in an Indigenous community, were assessed as outcomes. Survey items were grouped into five independent factors using principal component analysis and outcomes were modelled using multivariate regression analysis. Results: Students reported strong interest in Indigenous health but did not believe themselves adequately educated or prepared to work in Indigenous communities. When controlling for age and gender, a significant predictor of both (1) perceived importance of learning about Indigenous health and (2) interest in working in an Indigenous community was positive sociopolitical attitudes about Indigenous peoples. Knowledge about Indigenous health inequities was negatively associated with interest in working in an Indigenous community. Conclusion: In addition to teaching knowledge-based concepts, medical educators must consider the importance of attitude change in designing Indigenous health curricula to shape students' behaviours and ultimately improve physician relationships with Indigenous patients., Background/Purpose: With an increasing focus on attracting diverse students into a career in medicine, more outreach approaches are needed to showcase the different paths and lived experiences of students admitted to medical school. The purpose of this study is to explore how appreciative inquiry, a popular approach in change management, can be applied to promote student diversity in medical education. Summary of the Innovation: This study is conducted in three phases. First, an interview protocol was developed through an iterative process from two interviewees. A set of 15 questions from three domains (path to medicine, reflection, and emotions on medicine) was devised to provide a semi-structured interview process in exploring how students recall and reflect on their positive experiences in medical school. Second, a pilot of ten participants were interviewed in 30 minute in-person sessions. Participants included recent graduates and current students. Third, a collection of experience vignettes from each participant was then produced to share the successes, experiences, and challenges each student faced in entering medicine. Conclusion: The vignettes were storified and shared to promote and encourage students with a diverse set of experiences, training, and skills to consider a career in medicine. Appreciative inquiry is an informative method in collecting powerful memories and experiences in narrative form. Future study may expand on this method to validate and enable a broader participation of students across the program to further demonstrate and celebrate the diversity of students admitted to our medical education program., Background/Purpose: Transgender (trans-) people face significant barriers to accessing emergency healthcare, including delay or refusal of care, and harassment. A contributor is a lack of education in medicine curricula dedicated to gender and health. The purpose of this needs assessment was to identify current gaps in trans-health knowledge in emergency medicine. Methods: We conducted a mixed methods, multi-phase needs assessment, with the intention of discovering topics relevant to clinical clerks in emergency medicine. Data was collected from medical students attending the Canadian Association of Emergency Physicians Conference. Students participated in a written survey and/or focus group. Data was hand coded by the primary researcher and checked by a second collaborator. A simple thematic analysis was reported and used as the basis of curriculum design. We received an ethics exemption from our institutional review board. Results: In total, 44 students participated in the survey (n=44) and focus group (n=12). Respondents represented nine Canadian medical schools. LGBTQ+ health teaching ranged from none to three sessions. Approximately half of respondents reported poor knowledge of trans-related terms. Other themes included lack of approach in sensitive histories or physical exams, and perceived inability to advocate for trans-patients with staff physicians. Conclusion: The results of this needs assessment demonstrated a significant gap of trans-healthcare knowledge. Respondents identified key gaps, including gender-related terms, sensitive encounters, and advocating for trans-patients. The results of this needs assessments are pertinent, as they will guide the development of modules for a Canadian EM website (CanadiEM.org)., Background/Purpose: Physicians have a social responsibility to advocate for patients and ensure equity in healthcare for all. However, there exist inherent disparities amongst patients of different ethnicities in access to stem cell transplants. This is mostly attributed to the lack of non-Caucasian donors. As Canada's population grows more diverse, it is imperative to address this issue by educating young adults of the status quo, and ways in which it could be called into question. Summary of the Innovation: As such, we implemented “Donnons la Chance au Don” (DCD). DCD is a 60-minute interactive workshop intended to inform, sensitize, and mobilize high school and CÉGEP students on the issue of a lack of racial/ethnic diversity in stem cell donor registries. In collaboration with IFMSA-Québec and the Swab the World Foundation, students are provided with a brief overview of the science behind stem cell transplants (including the challenges associated with genetic compatibility), along with an up-to-date account of the state of registries worldwide. We explore and suggests avenues in which students can become responsible citizens and better the lives of patients awaiting stem cell transplants. Conclusion: Following this inaugural pilot year, DCD has been well received by students and teachers alike. 19 workshops were held in 4 anglophone and francophone Montreal schools by medical school students from Université de Montréal and Université Laval. A participant satisfaction survey measured outcomes related to the workshop. Out of approximately 700 students reached, 99% reported having a better understanding of stem cell donation, 95% are more conscious of current inequities in access to transplants, and 65% are more likely join the stem cell donor registry at the age of 18., Background/Purpose: Cultural safety and inclusion have become relevant themes in Canadian undergraduate medical education to reduce unsafe medical practices affecting Black and Indigenous patients. Less is known about culturally safe and inclusion-based initiatives supporting the social and learning environments of matriculating medical students from these populations. Culturally unsafe environments have been shown to increase burnout and depression within student cohorts. In effect, this knowledge gap of available resources hinders Black and Indigenous medical students and administrations aiming to maintain representation of these students. Methods: The objective of this study was to identify all staff, programs, and policies implemented to foster the cultural safety and inclusion of Black and Indigenous medical students. A grey literature search of the six Ontario medical school websites was conducted between July and August 2019. Relevant sources were organized according to leadership, organizational policies, student supports, and curriculum. Results: Each school has established staff in the area of Indigenous affairs, with variations in leadership supporting diversity and Black students specifically. Diversity statements also differ in their specificity to Black and Indigenous students. Every school has a cultural competency curriculum, although two specifically refer to cultural safety. Student supports vary broadly, including scholarships specific to Black and Indigenous students, student-run initiatives, conferences, and mentorship programs. Conclusion: By publicly mapping these initiatives, students are better connected to available resources and can optimize utilization. Administrations can also identify areas of strength and improvement, with the ultimate goal of graduating medical student bodies representative of the Canadian population., Background/Purpose: Female representation in surgery is increasing and several factors may contribute to this trend. The objective of the study is to assess the role of the Surgical Exploration and Discovery (SEAD), a 2-week immersive surgical summer program, on medical students' interest in surgery and gender-based perceptions of the field. Methods: Students' gender biases in surgery were assessed using a modified version of the Gender-Bias in Medical Education Scale (GBMES) administered pre- and post-SEAD. Mean difference for each item pre- and post-SEAD was calculated and differences between SEAD (n = 22; M/F = 12/10) and non-SEAD ( n = 18; M/F = 7/11) participants as well as between male and female SEAD participants were analyzed using t-test. Students' free-text responses were qualitatively assessed to further determine experiences and attitudes regarding gender bias in surgery. Results: Levels of interest in surgery did not significantly change between groups (P = 0.325). SEAD participants had significant reductions in the strength of the following beliefs compared to controls: “Surgery is male-dominated”, “Medical studies are mainly done in males”, “Gender discrimination is more pronounce in surgery than other medical professions”, and “Consideration of my gender is an important factor in whether or not to pursue surgery as a career” (P < 0.05). Stratified analysis revealed that the significance of these reductions were owing to female participants. Qualitative analysis revealed variable attitudes and experiences regarding gender biases in surgery. Conclusion: Early surgical exposure through SEAD reduces gender bias in surgery, particularly in female medical students., Background/Purpose: The Canadian College of Family Physicians introduced the Patient's Medical Home model in 2011 with a subsequent update in 2019. This evolving model of family medicine emphasizes access, continuity, comprehensiveness and team-based care that is community-centred and responsive. While the Patient's Medical Home is becoming more common, we sought to explore the degree to which preclerkship small group and assigned study clinical cases incorporate these elements of clinical care delivery. Methoids: All available clinical cases used in Year 1 and Year 2 preclerkship small group and assigned studies at the University of Manitoba were reviewed. Cases were analyzed for: specified care provider, patient age, type of clinical case, location, setting, referral source, resources, learners, technology, interprofessionalism, continuity and patient-centredness. Using stratified random sampling, 50 cases (6%) were reviewed by four researchers to discuss classification and analysis. Agreement was reached through consensus. Results: 844 cases were reviewed with 827 cases included in the final analysis. Of these, 47% of cases were from Year 1 and 53% from Year 2. 13% identified a family physician as a provider. 7% identified continuity and 8% identified patient-centredness. Only a few cases identified a referral source (6%), other team members (8%), community resources (1%), learners (5%) or technology (2%). A large number of cases had an unspecified care provider (78%), case setting (45%) or case location (91%). Conclusion: The Patient's Medical Home model is minimally represented in preclerkship clinical cases. Excellent opportunities exist to represent modern care delivery and family medicine in preclerkship with minimal case reconstruction., Background/Purpose: UK medical student exposure to surgical teaching is broadly limited to didactic lecture-based content, passive theatre observation, or often a single suturing session. Given the inherent dexterity required of surgical techniques, we evaluated medical student perspectives and exposure to practical surgical teaching. Methods: This was a cross-sectional, descriptive study for UK medical students. The study tool was a questionnaire comprising 5-point Likert scales and open-ended qualitative questions, reaching 230 students at 10 medical schools over a one-week enrolment. Qualitative data underwent thematic analysis to quantitively model past experiences as Integrated Curriculum (IC), Supplementary Workshops (SW), or Advanced Simulation Training (AST). We also compared metrics to pre-/post-course responses from an undergraduate microsurgical course that we recently developed. Results: 119 respondents (51.7% response rate), mean year of study 3.32±1.39 (range 1-6), were categorised as 12.6% AST, 22.7% SW, and 64.7% IC. The mean response to if practical training would influence career aspirations was 4.13±0.92, and to considering a career in surgery 3.38±1.31, which was similar to pre-microsurgical course responses 3.94±0.93 (p=0.1008) but had a statistically significant lower response versus post-course responses 4.63±0.62 (p=0.0003). The response to curriculum integration of surgical practical skills was 1.75±1.01, and to support implementation 4.38±0.78. Conclusion: Our findings suggest poor current integration of practical surgical skills teaching in the UK undergraduate medical curriculum. We outline a defined demand for future implementation and propose that gaining simulation exposure increases engagement in pursuing surgical careers, vital for future attraction and retention to surgical specialties., Background/Purpose: Learners report both a lack of education and a lack of positive role models as barriers to learning to care for the elderly (Meiboom et al 2015). The elderly population is the fastest growing population group in Canada and most physicians- whatever their discipline- will be caring for this group and most care will be provided in the community. Learning is most effective when it incorporates self-testing and reinforcement (Dunlosky et al. 2013). However, most medical schools in Canada provide teaching through lectures (which traditionally do not incorporate self-testing or reinforcement) and do not provide a compulsory geriatrics clerkship; for those that do, it tends to occur late in the undergraduate curriculum (Parmar et al. 2009). The cumulative effect is limited education. Summary of the Innovation: At the University of Alberta, a pre-clerkship elective has been developed targeting early exposure to clinical geriatrics in the community with effective learning strategies and leadership through seniors educating learners and a question and answer session with a medical leader in geriatrics. A 12 hour elective comprising an experiential visit to an award-winning seniors centre, clerking for a preceptor providing care in assisted living, case-based learning involving a skill, cognitive screening test, themed around the topical issue of driving assessments for seniors, and a Q&A session with an inspiring medical leader. Conclusion: On measures of attitude change, medical students viewed geriatrics more positively and intended to use a cognitive screening test in their clinical practice., Background/Purpose: There is little data on genetics teaching in Canadian medical schools. The objectives of this study were to: 1. Enumerate the hours of teaching 2. Describe the timing of delivery of content 3. Delineate the type of instruction 4. Describe the various professionals that teach 5. Outline the factors that inform objectives Methods: Undergraduate genetics leads were identified. A 10-question survey collecting data was sent via email to the leads at the 15 Canadian medical schools. Results: Survey results were compiled and examined. The survey was completed by 11 /15 (73%) of the leads. Most (90%) of content was delivered in pre-clerkship with 70% of schools having at least 16 hours. Lecture was utilized by all of schools, followed by small group sessions (72%). In one school, genetics was integrated into PBL tutorials. Independent learning events and patient contact sessions were also used to lesser degrees. Teaching teams varied. All schools had a MD Geneticist, with 90% using Genetic counselors, 63% Laboratory Geneticists, 45.5% physician trainees and 54.5% patients. Objectives for the curriculum were not uniform. Most were determined by either the course director/clinician (60%) or the university (40%) or combination. Conclusion: Currently, there is no standardization for undergraduate medical education in Medical Genetics. Timing of teaching is mainly in pre-clerkship, with a variety of teaching modalities and varied team. Understanding the current landscape of Medical Genetics teaching is useful in standardizing teaching, objectives and sharing of resources among the leads at various schools., Background/Purpose: Students are increasingly choosing non-surgical specialties. Observership programs can address factors influencing medical students towards surgical careers by allowing pre-clerkship exposure, mentorship, and changing misconceptions. Methods: A quasi-experimental convergent mixed methods questionnaire study design was used to determine the influence of a peer-initiated observership program on the career choices of preclinical medical students, and the factors pertaining to a positive experience. A McNemar test was used to evaluate the impact on students' career choices. An inductive thematic analysis was used to analyze students' reasoning. Results: Of 204 participating students, 85 (54.1%) answered both questionnaires. Most were interested in a surgical specialty prior to (84.7%, n=72) and after (84.0%, n=68) the observership. There were no statistically significant differences according to change of interest (p=1.00). However, most students (80.9%, n=68) reported being more interested in a surgical career as a result of the observership which allowed them to determine that the type of practice they considered was congruent with a surgical career. Their perceptions of the surgical field became positive, particularly towards its pace, climate and the humanistic patient-doctor relationship it required. The experience was influenced by surgeons' and teams' attitudes towards students, knowledge sharing, and quality of exposure. Students mentioned that their own willingness to participate was crucial for a successful experience. Results: This student-led observership program allowed an early positive introduction of students to surgery while challenging stereotypes. It provided a better understanding of surgery, enabling students to consider this field, and potentially influencing their residency application., Background/Purpose: Acquiring the technical skills necessary to perform surgery is crucial to achieving competency as a surgical resident. However, no formal surgical skills training is offered in pre-clerkship curricula. The Essential Skills Program (ESP) is a peer-assisted learning (PAL) program developed to increase pre-clerkship exposure to surgical skills. Summary of the Innovation: We used the Canadian Institutes of Health Research Knowledge-To-Action (CIHR-KTA) cycle for our program evaluation. Thirty-three medical students completed the program over one year. Using a 3:1 student:tutor ratio, learners were taught over two sessions, one week apart. Skills taught included the subcuticular interrupted suture (SIS) and the Fundamentals of Laparoscopic Surgery (FLS) intracorporeal suture (IC). Performance of IC and SIS were recorded. Students' performances were graded at baseline and at program completion using Global Rating Scales (GRS) and time to completion. Suturing scores were assessed via paired T-tests. Post-program feedback was assessed via survey. IC scores increased significantly between sessions one and two, from a mean time to completion of 417 seconds to 291 seconds. Mean SIS GRS scores increased significantly, from 57.8% to 71.3%, and time to completion improved significantly as well, from 576 seconds to 452 seconds. Survey results revealed that participants were motivated to improve technical skills for clerkship (94%) and felt more confident in their technical ability (93%) after completing the program. Conclusion: ESP is positively received by peer tutors and participants. This pilot program provides a potential framework for expanding surgical skill exposure to pre-clerkship students and implementing it within formal medical education, Background/Purpose: Medical students often have a difficulty selecting a Residency training program as the application deadline predates exposure to all departments. At the University of Ottawa, the six-week internal medicine rotation is entirely on the inpatient general internal medicine ward. As medical students with a particular interest in the specialty, we identified a need to increase exposure to various subspecialties of internal medicine in order to enrich our understanding of the field. This led us to create a two-week summer program that would give pre-clerkship students such exposure to assist with the Residency match. Summary of the Innovation: The two-week summer program for pre-clerkship students involved morning observerships, lunchtime career talks, and afternoon workshops in multiple subspecialties of internal medicine. The morning shadowing gave students a sense of common presentations in the subspecialty, the career talk was an opportunity to discuss lifestyle, the job market and opportunities in the field, whereas students practiced hands-on procedures in the afternoon such as ultrasound imaging of joints in Rheumatology. By the end of the program, students had a taste of nine different subspecialties of Internal Medicine. The program was inaugurated in June 2018 with 18 students participating. Conclusion: Overwhelmingly participants had positive feedback with regards to the program and felt that they were more prepared to make future decisions about Residency. We created a logic model in order to illustrate our program design and intended outcomes. Our hope is that our comprehensive model will facilitate the creation of similar programs at other institutions., Background/Purpose: During the University of Ottawa's Internal Medicine clerkship rotation students attend small-group Problem Assisted Learning (PAL) sessions reviewing various topics, assisted by a faculty expert. However, due to the heavy demands of this rotation, many students have difficulty preparing for the sessions, leading to valuable in-session time spent reviewing the basics rather than exploring the topic in greater depth. The objective of this student-led initiative was to determine whether providing students with video content tailored to PAL objectives would allow students to better prepare for and optimize their learning during PAL sessions. Summary of the Innovation: Short overview videos covering high-yield topics were made for 4 PAL sessions. Using a flipped classroom approach, students were able to use these to review basic information prior to their sessions. Following each session, students completed a survey assessing the utility of the videos. Self-reported knowledge levels and preparedness for the PAL sessions before and after viewing the videos were also assessed. Conclusion: Results (n=21) suggest that preparatory videos are welcomed by students as an efficient way to prepare for sessions. Thematic analysis revealed that respondents found the videos engaging and presented in a concise and logical manner, but would have further benefitted from a greater number of clinically-relevant examples. Comparison of students' self-assessed knowledge of the PAL topic demonstrated a significant increase after viewing the video compared to before viewing the video (p = 0.00048). Next steps involve modifying existing videos based on feedback from students and implementing this innovative study tool into the curriculum for future cohorts., Background/Purpose: While the lecture has been a core content delivery method in healthcare profession education; lecture attendance has decreased. Our objective was to define medical and nursing student perceptions regarding lectures and lecture attendance Methods: Second year medical students (in Spring 2018) and second year nursing students (in Fall 2018) were requested to answer a 10-item survey (consisting of Likert style, multiple choice, and short answer questions). Results: 110 medical students (response rate 35%) and 85 nursing students (response rate 40%) participated in the survey. The top reasons why medical and nursing students attended lectures respectively included: “lectures were mandatory” (81.8% and 69.9%), “socializing with peers” (68.2% and 28.9%), and “professor emphasis on important learning objectives” (67.1% and 91.6%). The top reasons for students included the perception that the lecture format was not effective (63.5% and 66.3%), preference for using lecture recordings (63.3% and 18.1%), and that lecture content was perceived to be of low relevance to the exam (37.5% and 33.7%), and the lectures were scheduled early in the morning (36.5%and 24.1%). Overall, 64.6% of medical students and 63.4% of nursing students agree that traditional lectures are an effective way of learning. Conclusion: The majority of medical and nursing students perceive that attending lectures still has value in terms of their learning, although medical students also state value for learning via lecture recordings. The emphasis on exam-relevant information and on student engagement are perceived by both medical and nursing students to be methods to enhance lecture attendance., Background/Purpose: As the Canadian population ages, there is a need for more geriatric care physicians. “Make a New Old Friend” is an intergenerational, experiential learning opportunity for medical students with objectives to: 1) Increase competencies in caring for older adults; 2) Enhance communication skills; and 3) Explore career pathways in geriatric medicine. Summary of the Innovation: The Waterloo Regional Campus of the McMaster University DeGroote School of Medicine implemented two iterations of “Make a New Old Friend” in 2018 and 2019, enrolling a total of eight students. Pre-clerkship students were primarily recruited due to their geographic stability. Students are matched with older adults living at a local Long Term Care (LTC) residence and faculty mentors who practice geriatric medicine. Meetings with older adults happen on a monthly basis to facilitate relationship-building. These in-person visits occur at the LTC residence to provide exposure to daily living of older adults. Students meet with faculty mentors to discuss their experiences and may arrange a shadow day. Students complete an attitude and interest survey to facilitate the matching process. Evaluations based on Kolb's Experiential Learning Cycle are completed by students and faculty mentors to consolidate learning outcomes. The volunteer coordinator from the LTC residence also conducts brief evaluations with the older adults. Conclusion: Students report high levels of satisfaction with this learning experience in follow-up interviews. The research team is investigating strategies to increase participation, and collecting feedback to guide future iterations. Intergenerational, experiential learning opportunities can be facilitated across levels of education and disciplines to support our aging population., Background/Purpose: As medical devices become increasingly important in the management of chronic diseases such as Type 1 diabetes (T1DM), both technological proficiency and understanding the patient experience are crucial for patient-centered care. However, effective methods of delivering a diabetes technology curriculum have not been described. Summary of the Innovation: We implemented a “Diabetes Bootcamp” in which trainees lived a simulated patient experience by wearing diabetes technology. The purpose was to promote experiential learning and to ascertain how this impacted practical skills in managing insulin pumps and continuous glucose monitors (CGMs). The “bootcamp” consisted of a 7-day period of wearing devices. Residents completed a pre-test attempting important day-to-day tasks of patients and clinicians, using an insulin pump with predetermined settings. After brief training, they were sent home wearing a saline pump and CGM, and instructed to adhere to guideline-based practices of a T1DM patient. After 1 week. they completed a post-test, feedback survey, and semi-structured group discussion reflecting on their experience, interpreting their reports facilitated by experts. Conclusion: All six residents reported increased confidence using technologies (4.50+/-0.55 vs. 2.67+/-1.03 on a 5-point Likert-like scale, p=0.006). Significant objective improvements occurred in modifying settings (92% vs. 71%, P=0.042) and overall performance (92% vs. 82%, P=0.007) on the post-test. Residents expressed insights into the lifestyle of T1DM, challenges of carbohydrate-counting, common logistical issues, and burnout in diabetes. An experiential learning program with hands-on assessment is an effective way to increase practical skills and empathy for patients with chronic disease., Background/Purpose: Physician reflection requires personalized, timely and growth-oriented feedback. Iterative learning from multiple low-pressure events can be personalized to target areas of weakness and show sequential growth. Since emergency physicians typically work individually to deliver episodic care, opportunities for them to obtain iterative feedback on their clinical performance is often limited. Our study sought to evaluate whether physician reflection is facilitated through the 72hr re-admission alert received by emergency physicians in the Calgary zone. Methods: This mixed methods realist evaluation consisted of two sequential phases: an initial quantitative phase examining the general features of 72-hr readmission alerts sent over a 1-year period (4024 alerts from May 2017-2018) and a subsequent qualitative phase involving 17 semi-structured interviews to generate “context-mechanism-outcome” (CMO) statements to guide refinement of our program theory. Results: CMO statements revealed emergency physician stakeholders were concerned that the alert impacted personnel decisions, changed patient return expectations and didn't involve consulting services. Physicians, who didn't believe alerts were involved in personnel decisions, were more likely to pursue balanced reflection/acquisition after each alert when receiving illness related returns. Conversely, physicians, who believed alerts were involved in personnel decisions, were more likely to defensively change their practice. Commonly cited areas of improvement were the ability to personally adjust time criteria for alerts and involving consulting services in feedback. Conclusion: Under certain conditions the individualized, timely feedback from a 72-hr readmission alert appeared to facilitate physician reflection., Background/Purpose: Au Canada, les coûts liés à la santé sont élevés. Dans les CanMEDS, la gestion des ressources est une compétence que devrait développer un médecin. Les étudiants en médecine doivent donc être sensibilisés à l'aspect financier des soins de santé. Ce projet a été réalisé dans un contexte d'éducation médicale à l'université d'Ottawa. Il visait à concevoir une formation portant sur « les tests inutiles » et vérifier l'effet de cette formation sur l'acquisition de connaissances des étudiants. Methods: Un MAA sur « les tests inutiles » a été conçu puis révisé par des experts. La formation a été offerte aux étudiants de troisième année suivant un modèle de classe inversé. Les connaissances des étudiants ont été évaluées grâce à un questionnaire auto administrée pré et post test. La comparaison des scores moyens obtenue avant et après la formation a été effectuée grâce au logiciel d'analyse de données quantitatives SPSS. Results: 48 étudiants donc 73% de femmes ont participé au projet. 76% avaient un âge compris entre 22-25 ans. Le score moyen obtenu par les étudiants avant la formation était de 9,7 sur 20 contre 11,7 après la formation. Les différences entre ces scores étaient statistiquement significatives (t : -3,45 et p : 0,0013). Conclusion: Un modèle de classe inversée incluant un MAA sur les tests inutiles pourrait contribuer à accroitre les connaissances des étudiants. Un deuxième post test sera réalisé deux mois après la formation afin de vérifier la rétention., Background/Purpose: Reflection - for learning and improving practice - is a part of the curricula for many health professions. There is an ongoing debate among scholars, educators and trainees about whether or not healthcare trainees should be evaluated on their reflective process. Consequently, few tools are available to educators who choose to evaluate the reflective process. This project aimed to: 1) document the academic debate on evaluating reflection, and 2) to review evaluation tools available in the literature. Methods: First, a meta-interpretation of the arguments in favor and against evaluating the reflective process was performed. Second, a scoping review of the literature was conducted to find evaluation tools. Results: Four arguments in favor of evaluating the reflective process emerged: 1) evaluation emphasizes the importance of reflection; 2) it ensures adequate depth of reflection among trainees; 3) it provides trainees with feedback on the reflective process; and, consequently, 4) it supports trainees' personal and professional development. Conversely, the four arguments against evaluation were related to: 1) how evaluation limits the learning process; 2) the amount of resources required to conduct evaluations, 3) the anxiety generated by vague evaluation criteria; and 4) low validity and poor psychometric properties of evaluation tools. In the literature, 31 evaluation tools - based on various theoretical models - were identified. Across the tools, 11 components to evaluate the reflective process were identified. None of the tools encompassed all components, but most included 3 to 5. Validity and reliability assessments, with reasonable scores, were presented for most tools. Conclusion: Beyond whether or not the reflective process should be evaluated, it is important to consider how the culture of evaluation in higher education affects evaluation of the reflective process. The choice of tools to evaluate reflection should take into consideration the context of use. Further research is needed with respect to the psychometric values of existing tools., Background/Purpose: Predicting factors that shape decision making around resuscitation preference for adults has been the subject of extensive study. However, existing reviews summarizing this literature are inadequate for supporting clinical training. In part because the underlying issues that need to be explored during a conversation have not been fully explicated. The purpose of this scoping review is to comprehensively and systematically synthesize existing empirical research on the factors that shape, and the reasoning behind how and why adults make particular decisions about resuscitation preferences for themselves and as substitute decision-makers (SDMs). Methods: Arksey and O'Malley's (2005) five-stage framework was used to describe the current knowledge base related to how and why adults make particular decisions around resuscitation preference. Of the 4,019 articles retrieved from the search of 4 databases and through citation tracking, 30 articles met the inclusion criteria and were included in this review. Results: Identified studies could be categorized across 3 categories: explicit exploration of resuscitation preference reasoning; implicit exploration; and correlational exploration. Across the study types, none fully addressed the broader issue of how and why patients or SDMs make particular choices in relation to resuscitation for themselves and others. Conclusion: To date, there continues to be a paucity of studies exploring the underlying issues that should be explored during a resuscitation preferences conversation with patients and their SDMs. This gap presents an ongoing challenge for training health professionals in how to effectively elicit resuscitation preferences. It also flags important areas for future research., Background/Purpose: The University of Ottawa MD program has two different streams to which candidates may apply: a francophone stream and an anglophone stream. As the admissions office receives applications in both French and English, they are required to ensure that the tools used to assess candidates are psychometrically equivalent across both streams. CASPer is a standardized test they recently adopted to assess the non-cognitive competencies of applicants and is offered in both English and French. The objective of this study is to compare the psychometric properties of the English and French versions of CASPer. Methods: We collected data from all CASPer test-takers across three cohorts (n = 12,463; entry 2016, entry 2017, entry 2018). We first compared the difficulty of the test between the French and English version using proxy indicators (i.e., time to completion, typing speed). We then compared the psychometric properties of the two versions based on their internal-consistency reliability and applicant acceptability. Results: There were some indications that the French version may be slightly more difficult than the English version of the CASPer test. However, it is unclear whether this difficulty is due to the difficulty of the individual test items or to differences in the characteristics of the cohort. Nevertheless, a comparison of the psychometric indicators suggests that both French and English versions of CASPer are psychometrically sound and equivalent. Results: Although CASPer scores cannot be directly compared between the English and French versions, the psychometric properties of the assessment were retained across the two versions. These results provide preliminary evidence that the psychometric strengths of the English version of CASPer likely extend to the French version of the assessment. Conclusion: Although CASPer scores cannot be directly compared between the English and French versions, the psychometric properties of the assessment were retained across the two versions. These results provide preliminary evidence that the psychometric strengths of the English version of CASPer likely extend to the French version of the assessment., Background/Purpose: Helping trainees develop their reflection skills is a challenge faced by many educators. One means to give value to the development of this ability is through credited courses and assessment. Yet, the assessment of reflection is fraught with challenges and potentially negative consequences. Based on an extensive literature review, we created a pass-fail assessment wherein mentors assess trainees' participation in a 4-year longitudinal course that aims to promote reflection on their professional identity and practice. Methods: We conducted a qualitative descriptive study using semi-structured interviews with medical students to document their perceptions, and thus potential consequences, of the assessment for the reflection course. The thematic analysis was informed by Braun & Clarkes' methodology. One author (JP) coded the interviews, with checking by other team members (KO, CSO). Three team members (CSO, KO, JP) discussed the coding structure extensively until they arrived at an interpretation of the data. Interpretation of findings was presented to the entire team and discussed until a consensus was achieved. Results: We conducted interviews with 21 1st year medical students and 6 2nd year medical students. We identified three main themes (subsequently declined into subthemes) in our data corpus: 1- consequences associated with the assessment of the reflection process (vs content); 2- consequences due to a pass-fail assessment; and 3- consequences associated with the mentors' dual role. Conclusion: Assessment of the reflection process, even when content is not assessed, may entail positive and negative consequences. When planning an intervention aimed at developing reflection skills, these potential consequences should be considered., Background/Purpose: A range of often implicit philosophical positions (e.g., post-positivism, constructivism, pragmatism) now underlie assessments programs in health professions education (HPE). Challenges may arise when assumptions and commitments informing competence, assessment activities and justification/validity are not sufficiently considered in assessment design or are in conflict. This includes a logical incompatibility leading to varied or difficult interpretations of assessment results or perpetuating an “anything goes” approach. Methods: This narrative study examined assessment literature in HPE to explore the plurality of philosophical positions informing components of assessment including competence, assessment strategies, and justifications/validity, as well as the need to consider coherence between them. We also examined philosophical tensions within health professions assessment research and in other fields (e.g., mixed methods research) to derive implications for assessment practice and scholarship. Results: There is a degree of indeterminacy in the nature of, definition and meaning given to competence, assessment strategies, and activities and validity/validation as a result of the different philosophical positions. These guide assessment differently and translate into different practical choices and interpretations about the quality and appropriateness of the assessment programs. Logical coherence can no longer be assumed. A “compatibility principle” which obligates attention to these issues of assumptions and commitments may help support assessment designs. Conclusion: Assessment in the health professions is broadening in its use of philosophical positions, which affect the “state of play”. This creates the potential for a logical incoherence that can undermine assessment programs but may be overcome with attention to the alignment between underlying commitments and assumptions., Background/Purpose: Twelve validated Palliative Care Entrustable Professional Activities (PC-EPAs) outline what Palliative Care (PC) residents should be entrusted to perform by the end of postgraduate training. For Family Medicine Enhanced Skills Palliative Care Programs (FM-ES PC), defining the specific competencies that comprise PC-EPAs for assessment has been challenging as many frameworks exist, including CanMEDS-FM and the College of Family Physicians of Canada (CFPC) Evaluation Objectives' Priority Topics and Key Features (KFs). We sought to clarify assessment expectations for these PC-EPAs by: 1)Defining PC-EPAs based on the CFPC PC Enhanced Skills Priority Topics and KFs by mapping and focusing chosen KFs as core competencies. 2)More accurately describing what competent performance looks like for each EPA. Summary of the Innovation: Our FM-ES PC Residency Program Committee members were assigned 1-2 PC-EPAs and asked to choose KFs considered to be essential core competencies for their assigned EPA(s). 12 PC-EPAs were mapped to selected PC KFs for our FM-ES PC Program. The average number of KFs per PC-EPA = 37 (3-107). Each KF was mapped (no “orphaned” KFs). Average number of PC-EPAs mapped per Key Feature = 3.5 (1-7). Mapping a set of chosen KFs as core competencies that define each EPA can validate the PC-EPAs and the CFPC KFs themselves, as appropriate, granular-level descriptors of competent performance by a FM-ES PC resident. Sufficient sampling of performance and enhancement of these selected KFs over time will be used to determine if a resident is entrustable in each EPA by the end of training. A nominal group technique will be used to establish consensus. Conclusion: This assessment approach may be beneficial to other FM-ES Programs by providing a suggested framework for summative and completion decisions., Background/Purpose: Fellows and participants in the Royal College of Physicians and Surgeons of Canada Maintenance of Competence (MOC) program are required to participate in assessment activities. This study examined data for five different specialties to identify variation in assessment activities; examine differences in the resultant learning; assess the frequency and type of changes that were planned; and assess the association between learning and change and between planned changes and discussion. Methods: Data from MAINPORT were categorized and analyzed descriptively. Chi-squared tests examined associations. Results: 6,063 assessment activities from 2,854 physicians were provided by anatomical pathologists, cardiologists, gastroenterologists, ophthalmologists, and orthopedic surgeons. There were differences in the frequency of learning by discipline and assessment type. The most frequent assessment activities across all specialties were self-assessment programs (n = 2122), feedback on teaching (n = 1078), personal practice assessments which the physician did themselves (n = 751), annual reviews (n = 682), and reviews by third parties (n = 661). Learning occurred for 93% (n = 5668) of the activities and was associated with change. For 2126 (35%) activities, changes were planned. A total of 1145 (18.8%) of activities involved a discussion with a peer or supervisor and these activities were more likely to result in plans for change. Conclusion: While specialists engaged in many types of assessment activities, there was variability in learning and plans for change. Organizations requiring participation in assessment activities might prioritize those requiring a discussion about data as they are more likely to facilitate planned change., Background/Purpose: Pharmacists are entrusted to assess, manage and educate patients who choose to self-select treatment for minor ailments. Prospective or retrospective entrustment assessments are customarily rated during training by clinician observers. Undergraduates should develop EPA self-regulation skills for working unsupervised as community pharmacists after licensure. Methods: Two cohorts of Pharmacy students (2nd year required self-care therapeutics course; 3rd year elective) performed classroom EPA assessments in their pre-clinical years to foster self-regulation for community practice training and to cultivate confidence. Structured EPAs were created for patient assessment, treatment plans and education using best practice guidelines. EPA rankings were anchored to five levels of supervision. Self and peer formative assessments (pre and post topic) were completed weekly to measure retrospective or estimate prospective entrustment for unsupervised practice. Pre and post course summative self and peer ratings were also compared. Post elective, students projected the ability to work unsupervised for peers who had not completed this additional optional training course. Perceptions were analyzed from observations, reports, surveys, class discussions and interviews. Results: Student reflections on pre vs post ratings highlighted feelings of increased confidence in estimated ability to perform in practice. Pre vs post self and peer ratings all showed advancements. Elective course students felt more prepared to work independently having had additional training. Conclusion: Students valued this opportunity to perform self and peer EPA assessments as training for self-regulated practice. It heightened their commitment to their professional role and stressed the importance of monitoring their entrustment expertise when working unsupervised., Background/Purpose: Although numerous studies have examined the effectiveness of peer-assisted debriefing of multisource feedback (MSF) reviews on physician improvement, outcome variations between genders, to the best of our knowledge, has not yet been explored. The general objective of this study was to explore whether gender influences physicians reflection on the MSF received regarding their practice and how they choose to respond to this feedback. Methods: This retrospective cross-sectional study examined MPAR peer-assisted reflective surveys completed by Manitoba physicians between 2011 and 2018. Survey responses were categorized according to the CanMEDS competencies and assessed to determine if there were gender differences in physicians' perceived feedback and changes implemented. Results: One hundred and sixty-nine physicians submitted the reflective survey (71% males). Physicians expressed receiving (unpleasant) unexpected/surprising comments mainly in regards of their roles as an expert (28%), communicator (26%), collaborator (25%) and manager (20%); and to a lesser extent to their roles as a professional (11%), scholar (7%) and health advocate (3%). A higher percentage of females (88%) who received a comment related to their role as a professional implemented a change for improvement in that area compared with their male counterpart (88% vs 33%, p=0.02). No other gender differences were found in physicians' perceived feedback or changes implemented. Conclusion: Results suggested that there were no gender differences on physicians' reflection on their practice after receiving MSF. However, female physicians were more inclined to incorporated changes to improve their competence as a professional., Background/Purpose: Multiple Mini-Interviews (MMI), a tool assessing non-academic skills, play a major role in the selection of future physicians who will provide health care to the population. Researchers interested in the psychometric qualities of MMIs have demonstrated the effects of factors related to examiners, candidates, and stations. The effect of station format used (interview or role-play) remains overlooked despite differences in the way skills are assessed, and the fact that station format is a factor over which programs have considerable control. This study aimed to compare the psychometric qualities of these two station formats. Methods: Scores from the 2010-2017 Quebec French Integrated MMI (n=11,173) were used to compare difficulty and discrimination as well as the reliability of the two station formats (276 interview, 246 role-play). Results from the 2011-2014 MMIs and the average clerkship rotation score of Université Laval's MD students (n=462) were used to compare the predictive validity of the two station formats using mixed linear regression. Results: Interview stations had a higher mean score than role-play stations, with a small effect size (M = 21.3 (SD = 3.1) vs. M = 20. 7 (SD = 3.4), p, Background/Purpose: Until 2018, at our institution, student applying to the MD program were selected for admission based on 2 criteria: a standardized grade point average (GPA) and a multiple mini interview (MMI) score. The GPA accounted for 50% of the total score for admission. With this study, we wished to answer this question: is the standardized GPA a reliable performance predictor for grades during the MD curriculum, and for the Medical Council of Canada Qualifying Examination Part I (MCCQE I)? Methods: From 2008 to 2015, data were prospectively collected from all students entering the MD program. Data included: GPA from pre-university or university studies, mean grades in years 0 (pre-med) 1 and 2, grades from project-based learning and courses throughout MD studies (eg: basic anatomy, digestion and nutrition, heart and circulation), end-of-curriculum written exam and OSCE scores, and MCCQE I results. Pearson's coefficient was used to analyse the relationship between these scores. Results: GPA showed weak correlation to year 0 (r=0.296, n= 646, p, Background/Purpose: Obesity and its related diseases are prime public health issues. In response to this need, a group of Queen's health education researchers and healthcare providers partnered with the Queen's Centre for Studies in Primary Care to develop an interprofessional professional development program on management of patients with obesity. Methods: The research findings were integrated in planning a one day program developed around a case study of a patient struggling with obesity. Obesity management topics were explored by an interprofessional team including a registered dietician, psychiatrist, exercise kinesiologist, endocrinologist, general internist, bariatric surgeon, family physician, and nurses. The resulting program educated 35 primary care providers (PCPs) to proactively manage patients with obesity using an array of available behavioural, psychological, pharmacological, and surgical approaches to improve healthcare outcomes in patients with obesity. Results: Over 90% of evaluations had perfect scores for confidence and increase in knowledge with the remainder being overwhelmingly positive. This universally positive reception of the content and its delivery, spurred subsequent CPD offerings with additional focus on interdisciplinary case studies. There were significant differences between participants in their level of confidence to engage in difficult medical conversations related to obesity, and in their knowledge of approaches to management of patients with obesity. Conclusion: The richness of the learning, the practicality of the topic, and the interprofessional focus of this program offers an exemplary model for other health education institutions interested in offering this program to address current challenges with management of patients with chronic diseases., Background/Purpose: Interprofessional education (IPE) is fast becoming a mainstay of health professions curricula. Well-designed simulation-based education can enhance IPE, where students and faculty are afforded rich experiential learning opportunities to learn about, from, and with each other. Summary of the Innovation: Our interprofessional healthcare educational team at Dalhousie University focuses on learnings from a robust interprofessional (IP) simulation-based education (SBE) program that has had multiple iterations. The integrated curriculum is facilitated by IP faculty and provides profession specific and interprofessional collaborative (IPC) team training to 400 students from six professions. The Collaborative Stroke Interprofessional curriculum is a two-part educational series comprising four hours of student interaction in IP teams. The first session is a high fidelity table top simulation incorporating best evidence and practice guidelines in stroke care. This session is preceded by flipped classroom modules for student pre-learning. The second session is a simulated stroke clinic with simulated patients and students working through scenarios in IP teams. The program is well-received and has demonstrated changes in knowledge and attitudes. Our IPC team will relate ways to make these IP programs successful in your institution, achieving significant IPE outcomes and administrative efficiency Conclusion: Our IP curriculum has demonstrated significant longevity and educational outcomes that can be replicated in your institution. Challenges and barriers will be discussed, as well as providing pedagogical suggestions for overcoming these concerns, so that in one's own work sphere attendees may develop a program that is successful and sustaining in its scope., Background/Purpose: Clinical care models, including the Patient's Medical Home (PMH), identify interprofessional teams as integral to optimal patient-centered care. These environments can provide authentic clinical learning opportunities for health professional learners. It is recognized that interprofessional education must ensure training in the context of the work environment so learners can develop the collaborative skills necessary to adapt to the clinical setting. Literature in this area is often focused on evaluation of select interventions or activities, with less emphasis on foundational structures and team culture that need to be in place within a clinical setting to optimize authentic learning experiences. Summary of the Innovation: An interprofessional primary care team in Winnipeg, Manitoba, Canada, provides comprehensive team-based care, in keeping with the PMH model, and regularly includes interprofessional learners. This poster describes the foundational structures and clinical activities within this team that support interprofessional learning and role modeling for health professional learners, as well as highlighting opportunities for ongoing optimization. Conclusion: Community-based primary care is well situated to provide authentic clinical interprofessional learning experiences for learners across health professions. Existing foundational culture and workflow are key to optimal collaborative experiences in this environment. This foundation provides seamless incorporation of students into the existing team and thus, meaningful and authentic clinical experiences. Using the PMH model to evaluate local adaptation can identify opportunities for authentic IP learning experiences., Background/Purpose: Healthcare disciplines each have their own distinct training, clinical practice framework and professional identity, leading to conflict and tribalism in team-based care. Team based research has focused primarily on critical care settings and interprofessional identity has not been well defined. This study sought to contribute to an understanding of power and hierarchy in a variety of healthcare contexts and develop a concept of interprofessional identity. Methods: Following Research Ethics Board (REB) approval, eight female health professionals participated in the study: 3 medical disciplines, 4 allied health and 1 from nursing. Participants completed an 8-module course on humanism and professionalism. Pre- and post-course qualitative interviews were conducted. Analysis was completed using phenomenology. From these data, an in-depth understanding of team functioning was obtained and a concept of interprofessional identity generated. Results: Leadership behaviour influenced team functioning and how individuals perceived their role. Team members had agency when their input was valued and disempowered when excluded or their input dismissed. Participants saw the patient differently when part of the team; this shift in thinking was transformative. Each discipline had the same new perspective focussed on the patient's goals and wishes rather than individual discipline goals. Conclusion: Team-based care continues to have issues of hierarchy and conflict yet can transform thinking around the patient. The proposed concept of interprofessional identity shifts the primary focus to the patient's needs and how each discipline helps meet them rather than approaching care from a discipline perspective. This could change our thinking around interprofessional education, team building and leadership., Background/Purpose: In an effort to emphasize our institutional appreciation of noteworthy professional behavior, The Center for Professionalism created the Power of Professionalism (POP) Award, which rewards exemplary professionalism and recognizes role models who demonstrate noteworthy actions, such as acts of compassion, empathy, selflessness and teamwork. Acknowledging individuals' noteworthy actions reinforces career satisfaction and decreases burnout. There is an institutional impact because the award documents that caring, professional behaviors matter and our organizational commitment to professionalism. Proactivity validating positive behavior may be more effective than remediating unacceptable behavior in the creation of a professional work environment. Individuals from all campus affiliates and all positions are eligible to receive a POP award, which has brought a sense of community throughout Baylor Summary of the Innovation: The POP Award is a successful, low cost method for recognition. Recipients include clinicians, basic scientists, medical and graduate students, residents, and staff. To date, 70 nominations have been received and 64 have been rewarded. The 32 awardees still at Baylor received an anonymous survey; 18 responded (53% response rate). A majority agreed receiving the award improved any sense of professional burnout, 89% felt the award validated their professional efforts and Baylor's commitment to professionalism, and 83% felt they were motivated to continuing to demonstrate the highest level of professionalism Conclusion: Will discuss the lessons learned in the creation of POP award and the measureable positive impact of this award. The POP Award has created an expanding culture, emphasizing positive professional behaviors, publicizing positive role modeling and giving personal and peer recognition, Background/Purpose: Health professional learners often experience significant distress that can impair their mental health, decision-making, and ability to thrive in their programs. Besides dealing with a demanding academic curriculum, clinical rotations, and constant evaluations, health professional learners also have to respond to their patients in a professional and compassionate manner. It is critical to equip learners with skills to problem solve and develop resilience within a challenging health care system. Summary of the Innovation: Since 2016, the WELL Office in the Faculty of Medicine at McGill University has been working to promote the well-being of learners from the School of Physical and Occupational Therapy, Ingram School of Nursing, and School of Communication Sciences and Disorders. The WELL Office is proactive in reaching learners through the Healthy Learning Curriculum and providing them with tools to becoming problem solving, critical thinking, and resilient health professionals. Concurrently, we are reactive in offering academic and mental health counselling. Curriculum topics include stress and time management, building resilience, finding positive solutions to negative interactions, managing perfectionism, grit, and leadership. The topics are based on feedback from learners in different forums, curriculum evaluations and exit surveys, and input from leadership, faculty, wellness consultants, and Assistant Dean, Student Affairs. Feedback has been positive and the desire for a longitudinal curriculum continues to grow. Conclusion: This presentation will share the implementation process of the Healthy Learning Curriculum, the nature of the curriculum sessions and feedback from learners, as well as recommendations for the successful development of a curriculum to foster health professional learners' well-being., Background/Purpose: Le développement professionnel continu en collaboration des équipes de soins est un défi au regard de contraintes du champ d'expertise des professionnels, de temps et des ressources disponibles. Une problématique comme la dysphagie est un domaine où la formation et la cohésion de l'équipe de soins (y compris le patient et son entourage) est essentielle. La formation par concordance est une méthode innovante qui, avec un minimum de ressources, pourrait permettre d'offrir une occasion de développement professionnel en intégrant la complexité d'un tel contexte. Summary of the Innovation: Nous avons créé une formation par concordance sur la dysphagie qui s'adresse aux professionnels des disciplines impliquées. Les buts: • D'être exposé aux perspectives de chaque discipline impliquée (patient, orthophoniste, ergothérapeute, nutritionniste, médecine et infirmière) • De mieux définir les contributions de chaque discipline • De réfléchir aux conséquences de cette compréhension pour sa propre pratique. Cette formation amène à percevoir le raisonnement propre à chaque partie (patient et différentes disciplines). Pour ce faire, nous avons généré des vignettes cliniques à partir de problématiques authentiques. Nous avons ensuite fait appel à un panel composé de professionnels impliqués et de patients avec une expérience en dysphagie. Chaque membre du panel a fourni des réponses pour chacune des vignettes en justifiant ses positions. Nous présenterons les étapes du processus et les défis que nous avons dû relever pour y parvenir. Conclusion: La formation par concordance permet d'offrir une activité de développement professionnel pour améliorer la collaboration en rendant explicite les perspectives distinctes et complémentaires des membres de l'équipe de soins incluant le patient., Background/Purpose: Le programme de formation en médecine M.D. sera entièrement donné en français au nouveau campus médical délocalisé en Outaouais de l'Université McGill en septembre 2020. Le principal défi est le court délai pour la réalisation de la francisation de tout le curriculum qui demande à la fois efficacité et qualité de la traduction. La tâche est particulièrement ardue en raison du jargon et des acronymes employés à travers les très vastes sujets des sciences biomédicales. Summary of the Innovation: Des bases de données lexicales bilingues, appelées MT (mémoires de traduction), ont dû être créées pour alimenter un logiciel de traduction assistée par ordinateur. Ces MT ont entre autres été bâties à partir de traductions officielles des objectifs d'études provenant des organismes régulateurs de la compétence des médecins en formation au Canada soit: le CMC, le CRMCC et le CMFC. Le contenu du curriculum étant majoritairement en format PowerPoint, donc avec peu de contexte, il fut difficile d'assurer la fiabilité de la traduction automatisée. Un processus de révision à plusieurs étapes a dû être appliqué pour y remédier. En plus des traducteurs, ceci impliquait le responsable académique, les responsables de volets/de cours, les futurs professeurs, etc. Conclusion: Le projet de francisation du curriculum jouit de plusieurs bénéfices: l'uniformisation du lexique de tous les cours; le développement d'un lexique médical anglais-français (québécois); le développement de moyens techniques et d'une expertise en matière de francisation de grands volumes de documents sur des sujets spécialisés; la mise en place de structures informatiques pour faciliter la gestion et la collaboration dans la révision des documents; un engouement des autres facultés de l'Université McGill quant à la francisation éventuelle de leurs programmes., Background/Purpose: Generalism is a widely held fundamental value in medical education. In recent years, medical schools have purported to emphasize generalism in their Undergraduate curricula. How are these schools assessing their level of success in accomplishing this goal? The literature does not provide evidence of a feasible or reliable tool, or a description of a program used to assess the degree to which generalism is included in learning materials. We sought to develop and apply an evidence-informed program to assess the degree to which generalism principles were present in our Preclerkship Undergraduate curricular learning materials and to provide recommendations to enhance generalist content. Summary of the Innovation: An environmental scan of the literature and accreditation documents was conducted to identify key elements of generalism and develop an evidence-informed tool. The tool was applied to 61 weeks of case-based learning cases. Feedback from clinician educators was sought and incorporated into the creation of the Toronto Generalism Assessment Tool (T-GAT). Subsequently, a study was conducted to assess the feasibility and reliability of T-GAT. Conclusion: This is the first report of an evidence-informed program to assess the degree of generalism reflected in medical education curricular documents. The T-GAT is feasible and reliable and can be used by other medical schools wishing to review their Undergraduate curricula from a generalist lens., Background/Purpose: TransEd is an online transgender health education curriculum developed to address the paucity of training in transgender health in healthcare professional schools. A study of six medical schools in Canada found that only two devoted more than eight hours of instruction to transgender related curriculum while the remaining allocated less than 4 hours of instruction. Self-reported comfort level showed that only 7% of students across Canadian medical schools actually felt “sufficiently knowledgeable” to assist a patient requesting hormonal therapy. TransEd is an innovative online curriculum that was developed through a grant from the Ministry of Training Colleges and Universities in 2015 to address this gap in education in medical training. This project looks at evaluating the effectiveness of an online TransEd program to address the knowledge gap, attitudes and comfort level in providing transgender healthcare. Methods: This project used the Kirkpatrick's four levels of training framework which is considered a gold standard for evaluating training programs. A mixed-methods approach using surveys and focus groups was implemented. After completion of the TransEd modules, Family Medicine residents completed a survey addressing knowledge and attitudes on transgender health. In addition, a focus group with a experienced and trained facilitator conducted a small group guided session exploring TransEd's effectiveness in meeting educational needs, perceived gaps in the modules and effectiveness in increasing comfort level in addressing transgender healthcare needs. Results: This abstract focuses on the qualitative analysis. A total of 6 Family Medicine residents participated in the focus groups. General themes that emerged including appreciating videos of true narratives that personalized the transgender journey and stories, a logical step wise approach to the modules, the practical approach to management options and the link to resources. Overall participants felt TransEd was a great foundation for transgender health knowledge and helped increase comfort levels. Suggestions for improvement included having more case examples that would model how to implement the guidelines in a practical manner and receiving ongoing training in these areas. Another limitation identified was the ability to transfer this knowledge into real life situations and the need to pair TransEd with clinical exposures and experiences. Conclusion: TransEd is an online education program that is an effective way to deliver curriculum on transgender health. Medical residents appreciated the practical approach that helped to increase their comfort levels in providing transgender care. However, pairing this with clinical rotations and experiences would further enhance the effectiveness of TransEd. Further research is needed to study the affect of TransEd on behavioural change in medical professionals providing transgender care., Background/Purpose: A medical school curriculum consists of thousands of scheduled learning events delivered by a body of instructors that is of the same order of magnitude. A comprehensive review of the curriculum is critical to its efficient and effective delivery. Curriculum overviews can be generated from several perspectives. For example, each session is associated with learning objectives, documenting the curriculum as it is planned. To gain the perspective of how the curriculum is delivered, the MD Program engages 8 to 18 students each summer to assign a set of keywords (nodes) to scheduled learning events and assessments. Together, the curriculum and assessment maps form a searchable database that can be used to analyze the coverage of a topic across the curriculum, discrepancies between planned and delivered curricula, or performance in certain topic areas. Methods: Over the last 5 years, summer mapping students were provided with a standardized list of 580 nodes, such as LMCC objectives or CanMEDS roles. Each student was then assigned a section of the curriculum to link these nodes to. Depending on the number of mapping students employed, this approach generated 2,000 - 10,000 linkages annually. While a standardized node list ensures consistency between students, the resulting map may not describe our curriculum to its fullest extent. In addition, without processing the data, the map provided little information about the relationship between nodes (e.g. “mutation” relating to “genetics”). To overcome these limitations, we revised our mapping approach to be student-centric. Rather than assigning a series of events to be mapped, we gave them the responsibility for one or more content areas (e.g. “biochemistry” or “ethics”) based on their pre-indicated interests. Students then determine a list of nodes relevant to this area and map those to any applicable event in the curriculum. Results: Democratizing topic selection and engaging students in defining content areas expanded the list of nodes to over 4,300 and doubled the map to 20,000 linkages. In addition, the map now groups nodes together in 27 content areas increasing the connectivity between topics. Conclusion: A simple redefinition of our approach strengthened students' commitment to the project and generated a more comprehensive map with greater connectivity between topics without increasing any of the invested resources., Background/Purpose: Learning normal child development and anticipatory guidance are objectives shared by the Royal College of Physicians and Surgeons of Canada for postgraduate pediatric training, Paediatric Undergraduate Program Directors of Canada, and Canadian Undergraduate Family Medicine Education Directors. Because developmental monitoring with standardized screening instruments is one way to accomplish this objective and there are no Canadian citations in the sparse screening curricula literature, we developed a novel curriculum for General Pediatrics (GenPeds) residents and examined availability of screening curricula nationally in Canada. Summary of the Innovation: Surveys to all GenPeds Program Directors (PDs) and Undergraduate and Clerkship Program Directors (UDs) for pediatrics and family medicine (response rate 14/17 GenPeds PDs, 6/17 pediatric and 9/17 family medicine UDs) showed most residencies value teaching screening to monitor child development, provided through lectures and hands-on practice in GenPeds clinics and Developmental Pediatrics (DevPeds) rotations. Screen teaching and use are absent in pediatric clerkships. Rarely used in other programs are short answer questions (SAQ), interactive workshops, and PEDS (Parents' Evaluation of Developmental Status)+PEDS:DM (Developmental Milestones). Introduced at our site were screening practice day in GenPeds clinics during DevPeds rotations (mean volume PEDS 11, PEDS:DM 3), interactive workshops, and longitudinal SAQ formative assessments. On evaluation, screen volume was strongly correlated with SAQ scores (r=0.452, p=0.016) and thinking it important to screen (r=0.385, p=0.032). Conclusion: National screening training, important in pediatric residency, could include high volume screening day with formative assessments., Background/Purpose: Pour les étudiants en médecine, la transition entre le pré-externat et l'externat est une période clé des études médicales de premier cycle. Ainsi, à l'université d'Ottawa (uOttawa), il serait primordial d'effectuer régulièrement une révision du curriculum, plus particulièrement l'unité d'intégration (dernière unité du pré-externat) et le stage préparatoire (première unité de l'externat). Notre projet de recherche visait à identifier les concepts clés qui permettraient d'améliorer la préparation à l'externat. Methods: Un mapping du curriculum médical de l'uOttawa a été effectué en le comparant à ceux des autres facultés de médecine du Canada. Par la suite, une recension structurée des écrits a été complétée afin de ressortir les concepts théoriques qui pourraient servir de fondement aux modifications du curriculum permettant une meilleure intégration des connaissances. Results: À l'uOttawa, l'unité d'intégration est divisée en 54% de cours didactiques, 19% d'activités pratiques et 21% d'ateliers. Pour le stage préparatoire, 22% sont alloués aux cours didactiques, 29% aux ateliers et 48% à la pratique en milieu hospitalier. Pour améliorer la préparation à l'externat, des modifications bénéfiques pourraient être apportées, notamment en priorisant l'apprentissage actif ; en mettant l'intégration cognitive en premier plan en salles de classe ; en introduisant les sujets les plus complexes à la fin du pré-externat selon une approche de cycle de vie ainsi qu'en associant une séance de développement des aptitudes cliniques à chaque séance d'apprentissage par cas. Conclusion: Nous avons réussi à suggérer des recommandations pour l'amélioration de la préparation à l'externat., Background/Purpose: During the 2017-2018 academic year, the PHASE Program was piloted with Year 2 (PY2) Entry-to-Practice (E2P) PharmD students at UBC. The program allowed students to see themselves as pharmacist-educators by providing a simulated teaching environment. Methods: During this pilot year, PY2 PharmD students participated in a didactic session on effective teaching and the following week, students were assigned to small groups where each student delivered a mini-lesson during an academic-half-day (AHD). Feedback was provided after each session. Quantitative survey data, using a Likert scale, was collected from students before the didactic session and after the AHD to evaluate students' beliefs about their confidence and competence in teaching. Qualitative data in the form of responses to open-ended questions were asked post-AHD to gather students' self-reflections about the simulated teaching session. Results: Before the didactic session, 39.8% of respondents agreed or strongly agreed that they are confident in their ability to educate a group. After the AHD, this number increased to 80.7%. After the AHD, the number of respondents who felt they are able to conduct an educational session increased from 42.8% to 80.3%. Analysis of open-ended responses revealed insight into how PHASE impacted students' beliefs about themselves as pharmacist-educators. Conclusion: Based on student survey data, the PHASE program had a positive impact on students' self-report that they are able to educate a group and conduct an educational session. Next steps include implementing and evaluating the second and third years of the PHASE program., Background/Purpose: Striving for excellence in our curriculum to ensure we adequately cover MCC objectives is critical for medical students and universities. At the University of Saskatchewan, we have developed a process to screen for significant curricular MCC gaps in our pre-clerkship and clerkship curriculum. Summary of the Innovation: Each of our learning objectives in our curricular management tool (One45) is mapped with an MCC objective. MCC gap reports are run for each course and results collated into an excel spread sheet with the MCC category along the top, course name on the side, and a numerical total at the bottom of each MCC category. The numerical total represents the number of individual curricular locations the topic is taught in the four-year program. This visually appealing colour coded table is easily interpretable by educational leads and other faculty members. Results: The collated report is analyzed and MCC categories that indicate fewer than 10 locations are identified and then investigated further. Key word searches and cross comparison are used to determine if the report is accurate or if content is being taught and merely insufficiently mapped. Identified potential gaps are then reviewed by the curriculum committee to determine if curricular change/supplementation is required. Conclusion: The development and utilization of MCC gap reports has enabled us to properly identify MCC curricular gaps and/or under mapping in our curriculum. Gap reports have allowed us to undertake a review of our curricular mappings to topic areas to ensure the success of our students and verify quality assurance. Additionally, the MCC curricular gap report supports our Curriculum Committee review process to efficiently and quickly focus on areas that are deficient in our curriculum., Background/Purpose: It is well-documented that student well-being is challenged in medical school. The Doctor of Medicine (MD) program at the University of Toronto developed a four-year resilience curriculum (RC) to encourage students to reach out for help and equip them with resilience-building strategies. Summary of the Innovation: In 2016, the first phase of the resilience curriculum was embedded into the core curriculum. The curriculum now spans all four years. The Resilience Curriculum (RC) is composed of online modules, small group workshops, and Monologues in Medicine, narratives of medical trainees sharing experiences of mental health, wellness and resilience. Recognizing that the onus of resilience is not just on the individual, faculty development to support the curriculum, as well as strategies to address systems issues have been incorporated into the curriculum. Conclusion: Preliminary data suggests students enjoyed learning new strategies and found the skills applicable to their lives and perceived some value in all activities. Students preferred the delivery of workshops over a lecture-based format noting that there was more engagement. Students also made recommendations regarding logistics of delivery such as workshop size, length and scheduled time. Faculty, student affairs staff and students developed and implemented the curriculum. Evaluation based on feedback from implementers and developers of the curriculum has recently been completed. The overall aim of this work is to contribute to a cultural shift in medicine that values and responds to the importance of physician wellness and resilience. This can only be accomplished through a collaboration of students, faculty and the larger medical community., Background/Purpose: The Jigsaw teaching technique (https://www.jigsaw.org/) was implemented into Professional Years (PY) 1-3 of a 4-year entry-to-practice PharmD program at the UBC. A Jigsaw classroom was used to teach HEENT dosage forms in PY1, respiratory dosage forms and diabetic devices in PY2, and contraceptives in PY3. Although this technique has been used in elementary and high schools, its use in healthcare education is limited. Summary of the Innovation: Prior to the tutorials, students were divided into groups of 6 students. One student from each group was assigned to be the lead for a particular topic or “segment”. The lead was asked to be prepared to teach their segment to their small group. At the beginning of the tutorial, all the leads for a particular segment met to solidify their knowledge and discuss teaching strategies. The student groups then rotated through six stations; during which each lead took turns teaching their segment to their group. The session concluded with a Faculty member reviewing the key points from each segment with the entire class. Conclusion: Based on PY1 student survey data and Faculty observations, the Jigsaw technique improved the student learning experience by reinforcing their learning by teaching and working collaboratively with their peers. Suggestions for improvements include more comprehensive preparatory materials and accountability for topic leads to be prepared. Next steps include expanding the use of this technique to teach other topics, and measuring its impact on students' retention of knowledge and skills and their teaching ability., Background/Purpose: Healthcare professionals must engage in lifelong learning to keep up to date with the immense amount of new information generated every year. A goal of competency-based medical education (CBME) is to support learners in developing good lifelong learning skills. Self-regulated learning (SRL) is a theoretical approach to explain how learners proactively self-direct their learning behaviours and cognition in formal or informal learning contexts. Learners who engage in adaptive SRL plan their time, organize their study strategies, and are flexible in their approaches to learning as determined by their goals. In this study we measured the SRL behaviours of incoming PGY1 residents at two Canadian residency programs to determine the level of SRL skills that residents bring into training. Methods: A survey was developed based on three existing validated instruments to measure residents' self-reported SRL skills and behaviours, including metacognitive self-regulation, critical thinking, cognitive awareness, and achievement goal orientation. Surveys were distributed at two residency programs in the first 6 weeks of the first year of residency. Ethics approval was obtained at both sites. Results: Surveys were completed by 50% of residents at Site A and 25% of residents at Site B. Self-reported SRL skills were similar at both Sites, with the exception of mean scores on Declarative Metacognition (A = 6.17; B = 5.53) and Information Management Strategies (A= 7.78; B = 8.03). Conclusion: This study provides insight into the SRL skills that learners have upon completing medical school, and gives the subject programs a baseline to allow for determination if CBME can improve SRL skills over time in residency training., Background/Purpose: Medical emergencies can happen anytime, anywhere, but some environments are complex and have specific needs and urgency. One of these environments is a medical emergency in the military, in particular in the field. Medics need continuous training and up to date information and we have been looking into an engaging way to convey this critical information with a focus on accuracy in the military context and a story that will stick and be memorable. Summary of the Innovation: For this purpose we have developed a graphic novel approach to tell relatable stories of military life with a medical emergency that requires an intervention. The story has its main component of the soldier developing an illness or a situation that requires an intervention and in addition to that there is a visual side story of the physiology of the internal organs and systems that are responding to the situation. This dual approach allows us to blend the development, presentation, and treatment of a medical emergency with the underlying physiology. Conclusion: This approach allows for the presentation of complex scenarios and how to deal with them in a military context in an engaging and comprehensive way., Background/Purpose: Curricular practical ultrasound classes become increasingly common in medical schools. These resource-intensive small group classes rely on healthy subjects performing ultrasound on one another and therefore often do not include any pathological findings. But it is the pathological findings that many young physicians are expected to recognize from early on in their residency which indicates the need to address these topics in undergraduate medical education. Methods: We conceived a lecture format addressing recognition and precise description of pathological sonographic findings. The topics of kidney cysts, liver cirrhosis as well as urinary obstruction were moulded into one case each with patient history and findings of physical examination, laboratory tests as well as abdominal ultrasound. 89 fifth-year undergraduate medical students attended this four-hour interactive case-based lecture session including 1. live demonstration of finding and measuring liver and kidneys, 2. describing and interpreting pathological findings together as well as 3. clinical decision making by integrating information from all available sources. Orientation and recognition of pathological findings were assessed via a short-written test before and after the lecture. Results: After the lecture, students scored significantly higher in correctly identifying 1. the liver (1 versus .52 out of one point) 2. the section level in a sagittal transhepatic image of the right kidney (.9 versus .29 out of one point), 3. the sonographic criteria for cysts (3.26 versus .86 out of five points) as well as 4. for liver cirrhosis (2.5 versus .55 out of five points) after the lecture. Conclusion: Our results show that students' orientation and recognition regarding sonographic findings can be increased by an interactive, case-based class resembling every-day physician routines. During evaluation students emphasized that particularly the integration of pathophysiological knowledge into the process of clinical reasoning was helpful. We plan assessing long-term retention of acquired skills after three months. Take-home message: Recognition of pathological findings can be taught effectively in a resource-sparing lecture format. Regularly and repeatedly including the pathophysiological background in clinical cases may contribute relevantly to students' understanding of the underlying disease., Background/Purpose: Within a complex healthcare environment and a rapidly evolving digital world, physicians need to be adept at identifying credible, evidence-based information online. To help meet that need, the College of Physician and Surgeons of BC (CPSBC) in collaboration with UBC Division of Continuing Professional Development (UBC CPD) developed the Finding Medical Evidence course in 2007. The course introduced Point of Care (PoC) online tools to optimize patient care. Recently, the curriculum, format, and branding was redeveloped to integrate best practices in CPD and adult learning principles. Summary of the Innovation: FAST Evidence is an interactive, small group workshop facilitated by the CPSBC librarians. Using real-life case examples, participants gain hands-on experience in developing effective internet searches to find credible and evidence-based medical information. At the end of the workshop, learners complete a Commitment to Change form to plan for practice improvement. To further support ongoing learning, participants engage in incremental post-program activities including a peer check-in and librarian coaching session. The post-workshop coaching session gives learners the opportunity to receive objective feedback and support from program facilitators. Evaluation data is collected directly onsite and at 12 weeks post-workshop. Conclusion: The onsite evaluation data indicates a 43% increase in participants' reported comfort level using PoC tools. Further, quantitative and qualitative data from the 12-week reflective activity demonstrates an increased level in confidence and satisfaction using the tools in practice. Overall, data collected suggests that this innovative program is effective in teaching physicians how to effectively navigate and find credible, evidence-based information at the PoC., Background/Purpose: Point-of-care ultrasound (PoCUS) is a bedside procedure typically performed in the emergency room to inform practitioners' clinical assessment and decision making. As PoCUS technology becomes increasingly available and integrated into rural practice, it is important that medical education resources grow and evolve with the changing landscape. By developing readily accessible education organized in a clinically-oriented interface, practitioners are better supported to care for patients at the point-of-care. Summary of the Innovation: Through collaboration with health care providers who seek to safely expand PoCUS practice across BC and user testing with the target audience, BCPoCUS.ca was designed to serve as a free, open access learning tool and educational database offering carefully curated PoCUS content. Content is grouped into three main thematic categories: (1) presenting problems, (2) organ systems, and (3) procedures, and an interactive home page with an optimized search feature enables visitors to efficiently navigate to their area of interest. Practitioners may consult rapid summaries during time-limited visits, or further their learning through videos and how-to guides outside of the clinical setting. Conclusion: As an educational tool, BCPoCUS.ca provides resources to simplify the challenging process of integrating PoCUS into clinical practice. Over 2,466 users from 81 countries have consulted the website since its launch on September 26, 2018. Through further user testing and consultation with medical practitioners during future development phases, the BCPoCUS.ca project will continually explore how engagement with a target audience can inform the development of an accessible, efficient, and timely tool that meets learner and user needs., Background/Purpose: Nurse trainees experience a variety of stressors in academic and clinical environments, including heavy workloads, challenging patient interactions, and conflict between staff. Occupational stress may lead to burnout, powerlessness, isolation, and attrition from nursing. It is imperative to provide trainees with coping resources to deal with stressors, prevent negative outcomes, and foster emotional well-being. Social support, within the context of support groups, has been found to have a beneficial effect on health outcomes within the nursing population. Summary of the Innovation: The WELL Office in the Faculty of Medicine at McGill University developed the Experiential Rounds, two confidential support groups for nurse trainees (N=20/each), which are offered as part of the academic curriculum. The Experiential Rounds are designed and facilitated by a Wellness Consultant and Registered Psychotherapist, with the goal of helping trainees share their clinical experiences, develop strategies to overcome hardship, build confidence and community. Evaluation results revealed that most students found the sessions useful and helpful to their academic and clinical journeys. Thematic analysis further revealed that students were able to: a) normalize challenges experienced, b) learn practical tools to manage stress, c) alleviate perfectionism, and d) share experiences in a confidential and safe venue. Suggestions included to have more sessions with smaller student groups. Conclusion: Experiential rounds may be a promising tool to enhance nurse trainees' ability to cope with stress. Embedding experiential rounds within the curriculum can validate the importance of emotional well-being for a healthier nursing workforce. Recommendations and feedback for implementation of sessions will be shared., Background/Purpose: Mistreatment (discrimination & harassment) is a concerning issue in Canadian Medical Schools. This study aims to identify how mistreatment changes when students transition from preclinical into clinical education. Methods: We surveyed preclinical students in 2018 and all years in 2019. Students were asked if they had personally experienced mistreatment. Data was available for 188 participants. Generalized Estimating Equations were used to examine how mistreatment changed between the two years and how it differed between two cohorts after adjusting for site of training, age, gender and ethnicity. Results: The proportion of the class of 2T1 reporting discrimination during clinical education in 2019 was 52.6% compared to 38.5% during preclinical education in 2018. The proportion reporting harassment was 32.1% vs. 17.9% (clinical vs. preclinical). The proportion of the class of 2T2 reporting mistreatment did not change between two preclinical years. When comparing the results between two years, the models indicate that the change for 2T1 in experiencing discrimination from 2018 to 2019 is greater than that for 2T2 (OR=1.9 vs. 1.4). The degree of cohort difference in year-to-year change in harassment is more substantial (2T1 OR=2.1 vs 2T2 OR=0.7). Differences between cohorts in mistreatment were noticeable in 2019 (OR=2.8 and 2.8 discrimination and harassment) but this pattern is not observed in 2018 (OR=1.9 and 1.2). Conclusion: This study provides evidence that mistreatment affects a significant proportion of medical students and although there is some variation between classes, the significant rise in incidence appears to be related to the transition from preclinical to clinical education., Background/Purpose: Competence-Based Medical Education (CBME) poses new challenges for accreditation and quality improvement of residency programs. Medical education is a complex enterprise, engaging such multi-faceted dimensions such as professional identity, and the need to balance personalized care that meets requirements of health systems. While CBME appears straightforward and self-explanatory, the formal model is challenged by context of implementation (system) and social reproduction of medicine (meaning). Lack of coordinated models of how medical educators could work to satisfy such complex and diverse requirements challenges the philosophy of CBME. Summary of the Innovation: To offer a potential model, the Office of Accreditation and Education Quality Improvement (OAEQI) adopted a team-based approach to support medical training in the context of diverse populations, the Quebec health system, medical education best-practice, and national accreditation standards. OAEQI functions through a tripartite service model that aligns curriculum, assessment and evaluation delivered through the lens of quality improvement and accountability in its various institutional and social dimensions. Our strength is our team. We are bilingual and demographically varied working collaboratively and deriving our expertise from psychology, medical anthropology, nursing, political science, education, medicine, and others. Our structure is enabling and humanistic in terms of work practice and deliverables. We illustrate this approach with a case study of a residency program. Conclusion: Our multidisciplinary approach enables identification of complex educational needs, barriers, and opportunities, providing an exemplar of Team-Based Quality Improvement. Our response model addresses residency program needs accounting for strengths and constraints, measures of outcomes and impacts, and feedback., Background/Purpose: Studies exploring speakers' effectiveness in Continuing Medical Education (CME) are lacking. This study sought to identify relevant presentation characteristics associated with speaker effectiveness in the context of CME. Methods: This study used data on speakers' evaluations from 26 CME presentations in various topics, which took place on five different days (between 4 to 6 lectures per day) in the academic year 2018-2019 at the University of Manitoba. Data was collected using an audience interaction tool for meetings (sli.do). Overall effectiveness of the speaker was rated using a 5-point Likert scale. Additional presentation characteristics evaluated (4-point Likert scale) were: a) the information was clearly presented, b) the presentation was balanced, c) the presentation was consistent with the stated objectives, and d) the presentation provided information which will influence my practice. Responses of speaker effectiveness were dichotomized (no/yes) to avoid celling effect. Statistical analyses were completed using logistic regression with Generalized Estimated Equations (GEE) clustered at the lecture level. Crude models explored at the association of speaker effectiveness with each characteristic at the time, and an adjusted model incorporated the four characteristics at the same time. Results: Nine hundred and ten speakers' evaluations were submitted from 266 anonymous participants, who provided evaluation for a mean of three lectures/day (min 1, max 6). Ninety-one percent of the responses rated the speakers as effective. Crude models indicated that effective speakers had statically significant higher scores in the four characteristics assessed (range between 2.5 and 3.3 points) than the non-effective speakers. However, the adjusted model indicated that effective speakers received higher rates only in the following items: a) the information was clearly presented (B=1.6, 95% CI 0.9- 2.3; p, Background/Purpose: Effective Continuing Professional Development (CPD) is needed to ensure a competent and sustainable health system. As new competency-based models of CPD come on the horizon, CPD scholarship is required to understand and optimize their impact, yet scholarship may appear undervalued. Our research question was what are the scholarly profiles, aims and needs of CPD program/conference directors? Methods: We developed, piloted and distributed a 35-item survey to 400 Program and Conference Chairs. Narrative responses were coded and thematically analyzed; quantitative data were analyzed using descriptive statistics. Results: We had a 20% response rate to our survey. Results indicate that most program/conference directors did not need to formally apply for their roles, but volunteered (37%) or were appointed (40%). Academic Ranks are distributed - 32% are Professors, 25% are Associate Professors, 32% are Assistant Professors. 62% have some training in education. 45% of respondents plan on conducting scholarship although 50% state that they do not have access to scholarly support despite the presence of research support/services. Lack of time, funding and the undervaluing of scholarship are listed as barriers to pursuing scholarly work. Conclusion: These findings build on an earlier interview-based phase of this study. CPD educators and leaders move into their roles in an unplanned way and face challenges in approaching their work as scholarship. In our large distributed network of CPD leads, existing scholarship supports need to be better publicized, with more advocacy work needed to ensure that CPD scholarship is recognized and valued throughout the system., Background/Purpose: In North America, despite the urgent call in 2003 to implement a significant health care reform, change has been slow or non-existent. Continuing professional development (CPD) aligned with the healthcare system and the evolving patients' needs is proposed as an agent of change to support this paradigm shift. Research Questions: What forces have influenced physicians' CPD in Canada over the last decade? What type of terminology, conceptual frameworks and methods are reported in the literature? Methods: Guided by a 6-stage framework, this scoping review covered published literature following these inclusion criteria: physicians, in Canada, available in English/French between 2008-2019. Five bibliographic databases were searched and data-charting was developed based on an iterative process. Studies were coded independently and reviewed in pairs to ensure accuracy and reliability. Results: Of the original 3761 references, 532 articles met our inclusion criteria. Two thirds targeted physicians alone. Sixteen percent targeted interprofessional teams, mainly composed of physicians, nurses and residents. Seventy-three percent of articles focused on continuing education techniques and approaches and 63% explicitly discussed clinical and non-clinical content areas. Workshops (15%) and case-based instruction (12%) were the most commonly used instructional methods. Of the articles reviewed, the terms “CME” and “CPD” appeared in 34% and 26% respectively and 11% cited a theoretical framework. Conclusion: This scoping review will contribute to the evolution of the CPD field by: keeping physicians up-to-date as clinical practitioners, teachers and scholars; informing CPD developers, licensing, regulatory bodies and policymakers, and identifying gaps for future research., Background/Purpose: The NOSM CEPD Office certifies and accredits a number of regularly scheduled series, including rounds, educational series, and journal clubs. In keeping with NOSM's distributed model rounds are organized by local faculty communities of practice, leading to the challenge of finding an efficient and effective way to audit these rounds for compliance with CFPC and RCPSC standards, while also maintaining a supportive, collaborative relationship with our faculty-led Scientific Planning Committees (SPCs). Summary of the Innovation: The office developed a short online survey requesting uploaded documentation across accreditation requirements, including promotional materials, conflict of interest, presentation content, identification and mitigation of potential bias, and record keeping. A review and escalation protocol mirroring the approval process allows any compliance issues to be identified and addressed. Conclusion: The most common compliance problems have been in ensuring all of the appropriate information is included in the promotional materials, and in ensuring complete record-keeping. Those filling out the audit survey found it was short and easy to comply. One noted afterwards that as soon as she looked at it, she knew what she needed to fix for next time. Making SPCs aware of the audit process ahead of time has helped to focus it on improvement and education, particularly for committees who are new to the process and requirements. Universal audits also help to mitigate the risk that non-compliance issues slip through the cracks. The online survey format allows us to track data over time and across programs with minimal additional work., Background/Purpose: An undergraduate radiation therapy program expanded to include provincial clinical practicum sites. Diverse procedures and technologies required deliberate mechanisms to support student learning needs. A continuous quality improvement (CQI) process was developed to assure ongoing quality, currency, and relevance of the curriculum to learners. CQI curriculum processes are ubiquitous. The purpose of this version - innovative to us - was to support equitable person-centered learning across a provincial education program, in a timely and nimble manner. Student growth was a reciprocal outcome of faculty and program evolution purposefully addressed via structured CQI. Summary of the Innovation: Weekly CQI was integrated into all clinical courses and involved Clinical Faculty (CF) at each practicum site and the Teaching & Learning Specialist. The collaborative process was ongoing and iterative; it was considered a standard component of the work done by CF. Adaptations and ideas were captured weekly, culminating in an annual review of all course competencies, teaching strategies, and evaluations. The changes were consistently infused into clinical course design, to accommodate rapid changes occurring in the radiation therapy environment. Conclusion: CQI reduced heuristic reactions to local pressures by providing a mechanism of checks and balances so CF made informed, reasoned decisions that were sustainable across clinical practicum sites. Faculty were challenged to become more holistic in course design and implementation, clinical partnerships, and student-centered teaching. It resulted in teaching tools and techniques that are now being expanded to didactic courses. Students reported positive perceptions of faculty support in practical and emotional aspects of clinical learning., Background/Purpose: Systematic reviews of quality improvement and patient safety (QI/PS) education provide descriptions of curricular content and teaching methods, but have not explicitly described how theory underpins QI/PS education. Using theory allows a more reflective rationale and deliberate approach to planning and delivering educational programs. We therefore undertook a scoping review to examine the extent, range and nature of the use of theory in QI/PS education. Methods: We identified articles describing QI/PS curricula targeting healthcare professionals in training and/or in practice that used theory to inform its planning, delivery, or evaluation using a systematic approach for search strategy and article review. Two team members independently extracted data from included articles. We synthesized data to describe the type and range of theories used, and how they were used to inform QI/PS education. Results: We identified 24 articles, mostly published between 2009 and 2017. Articles varied widely in terms of target professional group (e.g., physicians, nursing, pharmacy, etc.), stage of learning (undergraduate, postgraduate and continuing education) and journal type (e.g., education, QI/PS, health services). Studies drew upon a range of learning theories, including cognitivist, sociocultural, and transformative theories, as well as theories from psychology, sociology and philosophy. Theory was used to inform the planning and evaluation of QI/PS education programs. Conclusion: The breadth of theories identified provides insight into the range of lenses that are potentially relevant for planning and evaluating QI/PS education. Future directions include strengthening the rigour of the use of theory and extending the repertoire of theories used., Background/Purpose: The RMeMBC program connects Rural Pre-Medicine Program (RPM) students at Selkirk College with medical students in the Rural Medicine Interest Group (RMIG) at UBC. Due to geographic barriers, it is difficult for rural students to find “near peer” mentors. Likewise, medical students interested in rural practice are often studying in urban settings and feel disconnected from rural communities. The RMeMBC program provides a platform where these students can form mentoring relationships online. Summary of the Innovation: In collaboration, RPM, RMIG and the Rural Education Action Plan (REAP) developed a curriculum of eight modules highlighting the transition from undergraduate studies to medical education training. Once mentoring matches have been made based on common interests and experiences, students access the curriculum through an eMentoring software platform, and it helps to guide their conversations. Conclusion: Early results from the program indicate that mentors and mentees find the experience valuable. Interactions on the platform are generally focussed on the topics students identified as being important to them: the transition to medical education training and the needs of rural communities. One challenge which has presented itself is that portions of the curriculum are sometimes left unaddressed. Currently, we are exploring ways to encourage greater engagement with the curriculum while still allowing for organic conversations driven by participants' interests. Upon review, all partners view RMeMBC as successfully providing a resource that supports participants with rural backgrounds or affinities, and it could be replicated to support rural students across Canada., Background/Purpose: Each class year in our program quickly develops a reputation as 'hawks' (tending to evaluate learning events harshly) or 'doves' (leniently) based on anecdotal perception. This profile gets propagated throughout the faculty and staff. Is there any quantitative proof? Methods: Students at the Cumming School of Medicine are invited to complete a daily evaluation for each of their structured learning events. Over the last five graduating classes, we have evaluated over 30,000 events. Aggregating the responses of the students across years has provided a rich dataset to query. Students from the classes of 2016, 2017, 2018, 2019 and 2020 at the Cumming School of Medicine have evaluated 4442 of their lectures individually with the following question “Overall Rating” on a scale of 1. Unacceptable, 2. Below Expectations / Room for Improvement, 3. Good, 4. Very Good, 5. Outstanding. They complete these ratings within one week of the learning event. Results: Across those separate class years, the average lecture ratings are 3.91, 3.90, 3.87, 3.90 and 3.95 respectively. The standard deviation for that data by year is: 0.34, 0.43, 0.39, 0.39, 0.44, 0.46, 0.38, 0.47 Conclusion: We found that over the course of the five graduating years that their evaluations varied minimally in aggregate and were more similar than the classes' reputations would have indicated. This suggests that in situations where educational research requires a comparison of student evaluations across classes that inter-class variability is not a significant contributor to any noted differences., Background/Purpose: In Canada, many non-critical care residency programs include mandatory intensive care unit (ICU) rotations. During ICU rotations, specialty residents are expected to develop key clinical abilities required for the care of their sickest of patients. Yet, little is known about the learning opportunities encountered by residents during typical ICU rotations. Methods: We conducted a multicentered, prospective observational study in 3 mixed ICUs in Toronto, Canada, where non-critical care residents are supervised by critical care senior trainees and faculty. Up to four times during their first ICU month, consenting residents completed a diary survey that documented their participation in clinical (handover, rounds, procedures, admissions, resuscitations, family meetings) and educational activities (formal and informal teaching, self-study) over the previous 24h. Surveys were administered on a random day of the week (Monday to Friday) in order to sample different days. Results: Fifty-seven residents completed 153 surveys (median: 3 surveys/resident) that described 63 different ICU days. Whereas most surveyed ICU days offered an opportunity to participate in handover (90%), multidisciplinary rounds (73%), and formal teaching (73%), other activities were less frequently encountered (procedures: 46%, informal teaching: 44%; resuscitation: 35%) or rarely encountered (family meeting: 14%). Residents reported being the “main physician” (vs. assistant or observer) for 74% of all clinical activities in which they participated. A critical care trainee was the primary supervisor for 70% of clinical activities, and supervision was direct, indirect, or distant in 44%, 46% and 0.5% of the activities respectively. However, resident role and supervision varied significantly across sites. Conclusion: Better data on resident exposure and participation in valuable clinical and educational activities are important to determine what can be realistically learned and assessed during an ICU rotation as resident experiences vary greatly across sites and over time., Background/Purpose: Clinical Teaching Practicum [CTP] is a useful teaching instrument in a longitudinal faculty development program. Each participant is required to present 20-minutes of their clinical teaching, followed by 20-minutes of class discussion and feedback, on 3 different occasions over the 2-year duration of our program. Each presentation must demonstrate a different teaching modality (large group, seminar, “chalk talk”, bedside, simulation/procedure, or one-on-one teaching). Presenters shared teaching sessions that either “worked well” or areas where they encountered difficulty. Other program participants provide feedback and useful insights to problem solve with their colleague. Summary of the Innovation: CTP presentations in our program were observed and catalogued for content topics, teaching methodologies, innovation instances, nature/content of feedback, and participant satisfaction over 2-years (n=39 participants). A variety of content topics and teaching methodologies were encountered. Feedback was provided on visual presentation, choice of teaching/learning style, interactivity techniques, and teaching methodology. The sessions accrued a high degree of participant satisfaction. Participants highly valued the opportunity to experiment with new teaching methods, the teaching feedback they received and the self-reflection that it stimulated. Conclusion: CTP provides a high degree of classical face validity to an instructional development program. They illustrate the triumphs and dilemmas of teaching in the moment and facilitate class participants bonding and cohesion, as the group works together toward teaching solutions. CTP sessions provided a wide spectrum of teaching styles along with opportunities for teaching analysis and peer coaching. CTP can be strongly considered as a valuable component of an instructional development program., Background/Purpose: As postgraduate programs transition to an outcomes-based approach to curriculum, assessment and evaluation, there is evidence that faculty feel unprepared for the tasks necessary in a CBME context. This project aimed to harness the collective expertise and opinion of education leaders at U. of T. to determine their experience and needs with regards to FD in CBME. Methods: An online survey was distributed to program directors, faculty development leads and education leaders within programs that had transitioned or would be transitioning to CBME. Surveys were sent to 168 faculty members. Results: Overall survey response rate was 44.6%. Family Medicine faculty made-up 46.7% of respondents, followed by Medicine at 18.3%. 56.7% of respondents were Program Directors and 26.7% were FD leads. 80% of respondents had programs that had already launched to CBME. The top FD topics survey respondents would like to learn more about include: 1) Implementing CBME 2) Assessment tools 3) Feedback and Coaching 4) Competence Committees. The majority of programs felt that the ideal timing for CBME implementation was 6-12 months prior to implementation. The main perceived barrier to FD was lack of time amongst faculty. Conclusion: This survey is the first of its kind to evaluate the FD needs and experiences of multiple postgraduate programs in a CBME context. Its results are relevant to postgraduate programs nationally., Background/Purpose: As medical education evolved and a competency-based approach was adopted in clinical teaching, our faculty development had to adapt. To meet the different stakeholders' expectations towards primary care and clinical teaching, a comprehensive faculty development program was devised aiming at better integrating new teachers into their teams, promoting a deeper understanding and mastering of teaching skills and, mostly, developing the teacher's professional identity. Summary of the Innovation: The program: The one-year program used educational strategies allowing the progressive building and integration of teaching competencies: learning, experiencing and reflecting. Workshops were designed to help learn the medical education concepts and experiment them in a “safe environment” with role-playing. Participants were asked to put into practice the newly learned teaching/supervision techniques and concepts in their work setting and to discuss their experiences with a local senior colleague acting as a coach. Participants were also invited to share their favorable teaching experiences or difficulties in group discussions. Their examples were then used to further develop previously learned concepts and skills or to address new ones. Conclusion: The new teachers' faculty development program seems to have met the objectives set at the time of its creation. The health professionals (5 cohorts of 20-25 participants) who have completed it expressed their satisfaction at having been able to build a feeling of competence and a sense of belonging to a teacher community during the year., Background/Purpose: The INTAPT course is a foundation course for several Health Professions Teacher Education Programs (certificate, fellowship and Master's). Participants report global satisfaction and positive learning and professional outcomes. The course uses a variety of well-established pedagogical approaches to achieve learning. We sought to identify the most significant content and process components of the course that influence learning from the perspective of participants. Methods: After a preliminary pilot we asked participants to provide a brief narrative reflection about the key element of the course that had the greatest impact on their personal and professional development. In this phase we report data from a sample of 52 out of a total 107 program participants (recruited from the 2014/15 (by email) & 2015/16, 2017/18 (in person) classes) Reflections were analyzed using a descriptive qualitative method to identify common themes. Results: A variety of course processes (e.g. cultivating relationships with peers, balancing challenge and support, encouraging critical thinking) and course content components (e.g. application of education theory, presenting a workshop, acquiring a toolbox of practical skills) were identified as helpful to learning. Conclusion: In this analysis of our larger data set, we identified both content and process elements of the course that participants found impactful. Participants identified a wide range of factors. Faculty developers should utilize a variety of activities that challenge learners and at the same time support them to succeed. During this interactive poster participants will be able to place stickers next to quotes that capture their experiences in faculty development programs., Background/Purpose: Our challenge was to create a faculty development (FD) program that aligns faculty capacities and skills with goals and pedagogy of a new undergraduate medical curriculum that was undergoing significant innovation and change. Summary of the Innovation: To ensure alignment, an eight step situational analysis was undertaken to understand: (1) proposed curriculum changes; (2) faculty roles/tasks; (3) core knowledge, skills and attitudes required to perform the tasks; (4) faculty characteristics; (5) student learning needs/characteristics that may need to considered; (6) health care environment context in which the students will be learning and faculty will be teaching; (7) educational evidence used to inform curriculum renewal; and (8) potential impact on faculty and that may need to be managed. Using this approach, FD team designed a tailored strategy for each of 12 teacher roles. Tailored tools and resources as well as multi-modal learning design were adopted for each role. During the first 2 years of the new curriculum FD offerings included 82 workshops located close to faculty clinical practice, 4 webinars, 17 educational videos, 23 print materials, 5 e-learning modules, 186 Educafe Cafes that offer coaching in local communities of practice, and peer coaching. Evaluation and scholarship are embedded in the program development process. Conclusion: FD should be iterative and responsive to ongoing curriculum changes and newly identified faculty needs. Evaluation is key, specifically different FD modalities need to be evaluated to examine what can work, when, and why. Intentional alignment between FD and curriculum development can create a continuous quality improvement loop between the two practices that inform ongoing refinement of the curriculum i as well as the faculty resources and FD learning events., Background/Purpose: At UBC, we have created 3 innovations in our ultrasound curriculum over the last two years to deal with challenges in uptake, faculty recruitment and independent image acquisition. Summary of the Innovation: The ultrasound curriculum at UBC includes introductory abdominal, echocardiography and volume assessment. Student and faculty feedback was extremely useful in fine-tuning these sessions. With the desire to innovate, three additions were implemented: 1) faculty development session that was run at each of our DME sites. This consisted of an expert-facilitated session with an opportunity to provide an ultrasound curriculum refresher for faculty as well as ongoing mentorship. Recruitment for the next semester's teaching sessions was complete in record time. 2) a desire to increase the overall number of scanning opportunities from 3 to 7. Three demonstrations took place during the first weeks of term as ultrasound was modelled within the IPPA (inspection, percussion, palpation, auscultation) as an extension of the physical examination. This centred around a focussed ultrasound examination of the relevant system. Students were able to answer if their patient's dyspnoea was due to a pleural effusion, hypotension was due to a pericardial effusion or if their distension was due to ascites. 3) an online ultrasound log was created where students acquire 8 essential images including heart chambers/valves, neck and peripheral veins/arteries and views of the liver/spleen/kidneys. Conclusion: Students now have 7 different opportunities to scan during their preclinical years and can start acquiring images independently. Tutor recruitment is complete months in advance with high quality tutors. These interventions will better prepare our students to scan in clerkship and residency., Background/Purpose: In 2015, Queen's University embarked on an institution-wide transition to a competency-based medical education curriculum for all 29 postgraduate medical education programs. On July 1st, 2017 this goal was accomplished. With this extensive transition came the requirement to assess the efficacy of implementation through a program evaluation process which included the use of Outcome Harvesting (Wilson-Grau). Outcome Harvesting identified the intended and unintended outcomes of CBME implementation which helped us understand how the intervention was achieved, and how the relationship between behaviours and stakeholders contributed to the successful transition. Methods: A systematic approach to document analysis was used to categorize the 8 identified areas of implementation. Documents (N=443) were organized per project area, and then coded thematically. Documents were then categorized for attribution to outcomes using the Outcome Harvesting approach. Outcomes were validated via inter-rater reliability and substantiated by stakeholders to verify accuracy of formulation and plausibility of influence on the outcome. Results: The harvest produced 38 outcomes, either intended or unintended, that can be attributed to CBME implementation at Queen's University. Conclusion: Using Outcome Harvesting to assess the efficacy of CBME implementation produced a robust set of themes and resultant outcomes that can be categorized as requirements for success of implementation of any curricular innovation. Themes included collaboration, community of practice and stakeholder commitment. More unique observations noted through the harvest process included new policy development, creation of learner ownership and an increase in the output of scholarly activity involving CBME, Background/Purpose: Bien qu'ayant reçu une formation pédagogique, les équipes de cliniciens enseignants se sentent souvent démunies lorsqu'elles sont confrontées à des résidents en difficulté. Summary of the Innovation: Nous avons créé un service de consultation pédagogique (appelé SAMU) pour soutenir les cliniciens enseignants dans leur démarche de diagnostic pédagogique et d'élaboration d'un plan d'intervention. Fondées sur un modèle de supervision pédagogique semblable à la supervision clinique par discussion de cas, les interventions du SAMU visent à soutenir les compétences pédagogiques des cliniciens enseignants en les aidant à trouver des solutions adaptées à leur contexte. Les équipes d'enseignants s'investissent souvent beaucoup auprès des résidents en difficulté, au risque de s'épuiser. Dans ce contexte, le SAMU aide les enseignants à mieux définir leurs attentes et limites et à accepter que leurs interventions ne donnent pas toujours les résultats escomptés. Le principal impact de ce service est le sentiment des cliniciens d'être reconnus dans leur rôle d'enseignant et dans leurs efforts pour faire face aux difficultés des résidents. Il permet aussi aux enseignants, en formulant le problème, de dépasser la réaction émotive qu'il suscite et d'avoir un regard global sur la situation. Conclusion: Les cliniciens enseignants ont parfois besoin d'obtenir l'avis de pairs expérimentés lorsqu'ils sont confrontés à des situations pédagogiques complexes. Le modèle de la supervision pédagogique permet aux enseignants non seulement de discuter de diagnostics et de plans pédagogiques, mais aussi des enjeux relationnels et contextuels spécifiques qui influent sur leur capacité à intervenir auprès d'un résident en difficulté., Background/Purpose: Recruitment and retention of preceptors in medical student ambulatory clinic is challenging; reasons cited include hospital structures being more familiar and a lack of remuneration. We hypothesized that adding General Internal Medicine (GIM) fellows as teachers in internal medicine clinic would offer benefits. Methods: We assigned medical students to GIM fellows' longitudinal clinics. Fellows were responsible for the teaching and assessment of the students. We interviewed all stakeholders. Using a grounded theory approach and conversations with a key informant, we illuminated issues and propose best practices. Results: Students and fellows endorsed success. The students experienced a supportive learning environment with positive role modeling and felt they received good quality feedback. The fellows cited students' contagious enthusiasm and learning different skills as a clinic “junior attending”; many agreed they would continue to teach in clinic. Attending physicians had a mixed view. Those who had not taught students prior felt ill - prepared, while those who regularly teach students welcomed the addition. All agreed that the current model was untenable, due to the lack of organization. Conclusion: Having GIM fellows as teachers in the internal medicine ambulatory clinic is pedagogically sound, as it offers benefits to both sets of learners. In addition, faculty development is occurring at the level of the fellow, so as to recruit future clinical teachers in the concept of a developing community of practice. However, the operationalization was unsuccessful due to the chaotic nature. We propose a different organization which we hope will be a more sustainable solution., Background/Purpose: While the international focus has been the impact of rural rotations on the urban-based postgraduate learner, there are other stakeholders involved who should be considered. Within the Canadian context, an underserviced rural community may in fact be responsible for training an urban-based postgraduate learner. The impact of these rotations on the supervising preceptors has yet to be examined. This research focuses on seeking to understand the impact of rural rotations for urban post-graduate learners on the rural preceptor. It adds to the literature that seeks to evaluate educational initiatives implemented to respond to the social mandate of serving underserved populations. Methods: A mixed methods design was used. Data collection started with an electronic survey followed by a voluntary semi-structured interview. The survey was designed based on a literature review and refined by a focus group of experienced rural teaching physicians. The interview tool was refined using principles of grounded theory on emerging themes and continued by an interviewer not affiliated with the program until saturation was achieved. Thematic analysis was completed using a constant comparative approach. Results: All rural preceptors (75) that have responsibility to supervise urban based residents in the UCalgary Fam Med residency were surveyed. Over 60% response rate was achieved and from these 15 interviews were completed. There was no difference in preceptor opinion based on demographics. Interview thematic analysis revealed three significant impacts on rural preceptors stratified into personal, professional and financial. Mitigating and coping strategies were identified. Conclusion: Urban based residents have a significant impact on rural preceptors that has heretofore not been quantified., Background/Purpose: Research suggests that there are differences in clinical learning experiences and that these differences are influenced by resident gender. This study was conducted to understand family medicine residents' experiences and perspectives regarding clinical learning experiences based on resident gender. Methods: Focus groups with second year family medicine residents from 3 academic community-based teaching clinics in Calgary were completed between July 2018 and June 2019. Convenience sampling achieved variation in participant gender. Focus groups were audio recorded and transcribed. Transcripts were reviewed by 3 investigators and subjected to thematic analysis with constant comparison. Results: Focus groups with 23 residents; 11 men and 12 women. Residents who where men described less clinical exposure to patients of other genders (e.g. women's health and obstetrics). The reverse was generally not the same for residents who were women. Other Influencers included a preceptor's patient population, patient preferences, the clinical context/acuity context in which patients were seen, and how the resident was introduced to the patient. Residents responded differently to their experiences and 3 categories were identified: idealistic, pragmatic, and fatalistic. Impact to residents was described as current (loss of confidence, feeling unwelcome) and future (less likely to pursue a particular clinical area). Conclusion: Education programs and clinical teachers should be aware that resident gender is not the only factor that influences clinical learning experiences. Preceptor and patient factors are important. Residents perceive that how they are introduced to the patient matters. Differences in clinical learning experiences based on resident gender has impact., Background/Purpose: Family practice residents typically receive little training in the management of alcohol and opioid use disorders through their residencies. Not all teaching sites have faculty expertise or clinical opportunities for residents to acquire the skills necessary to manage addiction related issues. To address this gap, we piloted an addiction medicine curriculum with residents affiliated with one teaching site of the Department of Family and Community Medicine. Summary of the Innovation: Our program involved four 2-hour teaching sessions over a two-year period using a “flipped classroom” approach; learners were expected to review specific topic modules online, followed by face to face sessions focusing on case-based discussions, facilitated by a family physician with addictions expertise. Each session focused on a specific substance use issue. Patient management resources were distributed after each session and a repository of resources was maintained online. Participants completed post teaching session surveys. Increases were identified in all measured parameters: confidence in identifying patients with alcohol and opioid use disorders and in offering brief counseling interventions to patients with alcohol and opioid use disorders; likelihood of prescribing anti-craving medications for patients with alcohol use disorder, and likelihood of prescribing buprenorphine for patients with opioid use disorder. Conclusion: A relatively brief educational intervention can lead to increased confidence in managing alcohol and opioid use disorders amongst family practice residents. The materials used for this pilot could easily be shared with different teaching sites to reduce the workload for facilitators. Follow-up measures to assess practice patterns would be beneficial, Background/Purpose: Canadian accreditation standards in both Undergraduate and Postgraduate education now include an expectation of support for residents to develop competency as teachers. Developed in 2001, the Department of Family and Community Medicine at the University of Toronto's Teaching Residents to Teach Program (TRT) is one of the longest running resident-as-teacher training programs in Canada. Given significant changes in national curricular design, and the evolving role of resident teachers in undergraduate medical education, we undertook a critical review of the TRT to help inform future iterations and innovations. Summary of the Innovation: A three-pronged approach was employed to provide an evidence-informed process of program evaluation. This included: analysis of 18 years of student evaluations on individual modules; a comprehensive literature review to examine current best practices regarding content and processes; and a survey of recent graduates to better understand the current resident experience with the program. Conclusion: Evidence of highly positive evaluations of TRT over 18 years confirmed ongoing resident satisfaction with content and format. Recent graduates reported regular engagement and positive experiences in a wide range of teaching settings. Identified barriers to enhancing teaching opportunities included disparity among sites in a distributed curriculum, competing resident priorities, and a need for improved processes to connect residents with available opportunities. The results of this evaluation process will facilitate an evidence-informed approach to the development and delivery of future TRT modules both locally and nationally., Background/Purpose: Despite increasing numbers of women in medicine, the proportion of women compared to men in academic medicine remains low. Buell D, et al. identified an under-representation of women presenters in medical grand rounds (BMJ Open, 2018). Psychiatry has traditionally attracted a higher percentage of women than many other specialties. We sought to determine whether there is equal representation of men and women at Dalhousie's Dept. of Psychiatry grand rounds. Methods: Grand rounds data from 248 presentations between Fall 2012 and Spring 2019 were categorized and analyzed according to gender of presenter. Rounds types included Clinical Academic Rounds (CAR), University Rounds (UR), Child and Adolescent (CA), and the annual R.O. Jones Lecture (ROJL). When not known, gender was inferred from presenter names and additional demographic information available through internet searches. When presentations had multiple presenters, those with at least one female were included in the number of presentations by women. Results: Overall, women were represented in 52% of grand rounds presentations. Presentations by women occurred in 64% of CAR and 56% of CA. However, women were significantly under-represented in the more prestigious UR, which are offered by invitation to senior academics from other centres (27% p = 0.0001). For the Department's major annual lecture (ROJL), there was equal representation of men and women (43%, p = 0.27). Conclusion: Women are equally represented in Psychiatry grand rounds but are under-represented as University Rounds speakers. Further analysis would help to clarify reasons for this disparity., Background/Purpose: Clinical relevance is the gold standard to assess whether basic science delivery content is in line with clinical knowledge development. To achieve meaningful learning, delivery content needs to be applicable to build clinical competence. Many attempts have been made to restructure the delivery of basic science in coordination with clinical case-based learning formats. However, the current approach appears to only address re-scheduling of delivery timing, without truly revamping the content to meet the need for clinical knowledge development for the modern healthcare landscape. The challenge lays primarily with navigating through the complexity of clinical knowledge to filter and develop content that is deemed clinically relevant. To achieve meaningful learning, it is essential to generate a comprehensive tool to assist content developers in effectively visualizing levels of clinical relevance. Methods: In the current pilot, we utilized social network analytical algorithms to identify key influencers to map the connectivity of basic science contents specifically related to histology and pathology, to routine practice, red-flag symptoms and disease prevalence. Results: We have developed a comprehensive tool to visualize the connective network of clinical knowledge with basic science content. Conclusion: The development of a clinical relevance network utilizing social network analytical algorithms assisted content developers and learners to navigate and sift through the mountains of clinical knowledge to focus on clinically relevant content., Background/Purpose: Precision Medicine, Precision Education, Precision, has caught the imagination of many in medical education leadership. Extending the concept of data-driven approaches to personalized learning has its merits but are we ready for this? Despite increasing reliance on technology and painful lessons from malware strikes against our infrastructure, our CRAWWLA project clearly showed the widespread attitude: it's somebody else's problem. Attitudinal ambivalence extends to privacy concerns: learners raise concerns about their schools examining their workflows too closely and yet happily share vicarious moments of their personal lives with known malfeasants such as Facebook. Summary of the Innovation: We developed DSIP: a framework for assessing and addressing the challenges of organizational readiness, as we move towards the use of big data in learning analytics. Data readiness (micro level) - what data are needed, where to find it, is it valid? System readiness (meso level) - where is data stored, is it protected, is it integrated? Institutional readiness (macro level) - regulatory compliance, who pays for it? Personal readiness (mono level) - is it relevant, useful, worth the effort? Is my identity threatened? As we take a few cautious sips from the data firehose that threatens to drown us, we can put the appropriate measures in place to make these transitions palatable. Conclusion: Built upon the TIRRE model for research readiness, this four level model helps the leadership, and the future participants, at various levels from program to department to faculty, to anticipate the upcoming challenges and explore potential solutions., Background/Purpose: Whilst there is evidence of attempts to address the increasing complexities of selecting and educating tomorrow's doctors, little research has focused on the experiences of those stakeholders most affected by medical practice and malpractice, particularly patients. This study aims to address gaps in the medical student selection and education literature, as well as in the stakeholder-based literature. Methods: A qualitative approach, utilising phenomenological hermeneutics to explore participants' 'real life' doctor experiences via 39 individual and eight group semi-structured interviews. Data were audio recorded, transcribed verbatim, anonymised and imported into computer assisted qualitative data analysis software. An analytical methodology based on Smith's (1996) Interpretative Phenomenological Analysis (IPA) was applied iteratively to yield two broad phenomenological themes of positively and negatively evaluated doctor experiences. Results: The most compelling participant experiences were captured verbatim as part of the study's analytical commentary. Positively evaluated experiences focused on doctors 'being patient-centred' and 'good communicators', whilst negatively evaluated experiences focused on doctors 'being unprofessional' and 'compromising their own safety as well as that of others'. Conclusion: The study impacts ongoing attempts to better inform medical student selection and education. It offers strategies to refine the range and prioritisation of capabilities for enduring and effective medical practice from a more inclusive and unique stakeholder perspective., Background/Purpose: Palliative care is complex, challenging and emotional, more-so in rural contexts with limited resources, broad scopes of practice, and relationships entangled across personal-professional barriers. How palliative care learning happens is poorly understood and education efforts must focus on supporting professionals to navigate their unique circumstances. In order to explore how practicing rural physicians and nurses learned to provide palliative care, methods that capture depth and complexity of experience, and how contextual influences are perceived are required. Methods: Rich picture, a visual research method that uses participant-generated drawings to both evoke and record insights into complex situations, was used in combination with semi-structured interviews to recount narratives of memorable palliative care learning. Participant rural physicians (n= 9) and nurses (n=6) were invited to draw their experience followed by an oral exploration of their story. Results: This combination of methods resulted in vivid, emotional stories. Across all interviews, participants highlighted the role rich pictures played in their ongoing reflections about the particular situations they experienced, as well as the lessons learned. Participants welcomed the opportunity to “put myself in their shoes, in the family's situation” that rich pictures offered and that could not be expressed “just by talking”. Conclusion: Participants described rich picture drawing as enlightening and providing insight into multiple dimensions of their complex experiences that were not evident before the exercise. We suggest this method can be used as a reflection tool to derive deeper understanding of challenging lived experiences., Background/Purpose: Labour and delivery (L&D) units can be contested workplaces with tensions between obstetrician, nursing, and midwifery practices. These tensions can impede communication and raise patient safety concerns. Remedying such tensions requires study of the driving forces contributing to these recurrent problems in interprofessional practices. Methods: Our institutional ethnography study initially used critical incident analysis reports to identify recurrent issues related to transfers of care (TOC) and consultation requests between midwives and obstetricians. We then mapped the work of midwives, nurses, family physicians, and obstetricians by observing (75 hours) and interviewing them (n=15). We also traced work processes to local (forms and hospital policies) and external texts (national policies and evidence-based guidelines). Final analysis made visible the otherwise hidden links between everyday work of L&D practitioners and higher-level coordinators. Results: We identified three work processes involving midwives consulting obstetricians: induction with TOC back to midwife, consultation without TOC, and TOC. Three points of disjuncture complicated these processes: a local “3 consult rule”, linked to higher-level medical-legal governance and remuneration structures; subjective interpretations of the “4cm dilation rule”, a policy meant to standardize practice; and regulations that delayed timing of consultations. Conclusion: Our study extends existing research demonstrating that medicine-driven governance of midwifery practices can perpetuate interprofessional challenges. For example, the “3 consult rule” was established for patient safety purposes, but in practice can actually function to delay and disrupt work processes, potentially compromising patient safety. While practitioners spoke of the three points of disjuncture as 'laws', most also viewed them as ostensibly modifiable., Background/Purpose: La télémédecine soulève des enjeux de formation liés à la réorganisation de la communication patient/médecin et au fait que l'information sensorielle est modifiée et redistribuée - voire compromise - par l'utilisation d'un dispositif de télémédecine (Maslen et Lupton, 2018). L'impossibilité de toucher une plaie, de palper un abdomen peut compromettre la capacité du médecin à poser un diagnostic (Miller, 2003). L'objectif de notre étude est d'étudier la réorganisation de l'activité communicationnelle et sensorielle lors de téléconsultations médicales afin de développer un outil de formation. Methods: En collaboration avec le laboratoire de simulation d'un hôpital ontarien, un scénario de téléconsultation d'un suivi postopératoire en orthopédie a été conçu. Dix médecins ont réalisé ce scénario et ont été filmés afin d'analyser les interactions patient/médecin lors d'un examen clinique à distance. Ensuite des entretiens d'auto-confrontation ont été réalisés produisant un cadre d'interprétation de la pratique clinique par les médecins eux-mêmes. Results: L'analyse multimodale des téléconsultations et des entretiens nous a permis d'identifier les stratégies mises en oeuvre par les médecins afin de créer une co-présence à distance rendant possible l'évaluation sensorielle du patient, à savoir : (a) procéder à un cadrage de l'interaction établissant une proximité à distance; (b) établir un cadrage clinique via des engagements corporels et (c) réaliser un guidage instructionnel soutenant l'évaluation sensorielle à distance. Conclusion: Ce travail d'analyse est un préalable nécessaire au développement d'une formation qui permettra aux médecins - à partir de la présentation de situations d'interaction - de se familiariser avec les stratégies identifiées au cours de la recherche., Background/Purpose: The electronic health record (EHR) is an increasingly common platform used in medical settings to capture and store patient information. The implementation of EHRs has been shown to be both positively and negatively impactful in terms of provision of clinical care, depending on the domain analyzed, suggesting that such implementation should not be assumed to be a neutral event. Sociomateriality theory suggests that EHRs can also play a role in workplace-based learning, but very little has been published to date about how EHR implementation affects educational practice from the point of view of clinician-learner interaction. Better understanding such effects will allow better support of learners and educators during clinical transitions to EHRs. Methods: Using a grounded theory approach to data collection and analysis, semi-structured interviews were conducted with a group of practicing oncologists who work in outpatient clinics while also providing education to medical student and resident trainees. Data regarding perceived impact on the teaching dynamic between clinicians and learners were collected prior to implementation of an EHR to lay the groundwork for more extensive study. Results: Physician educators perceived that EHR implementation will impact educational practice for both teachers and learners. First, EHR implementation is expected to influence teachers' enthusiasm and interest in teaching as well as their ability to teach as much as they want or in a way they feel best supports trainee-learning. Second, EHR implementation is expected to influence learners by changing what is taught, what is modelled, and their role and involvement in both clinical care and the educational dynamic. Conclusion: Understanding the anticipated impacts of EHR implementation offers potential to allow positive changes to be made that might ease the disruptions caused by future implementation and provides a foundation from which to assess educational impacts during implementation research., Background/Purpose: The study objective was to determine the current usage of simulation based medical education (SBME) in Canadian undergraduate medical schools, as well as to elicit associate deans' (or designate) views on the use of simulation in medical schools. The current state/usage of simulation in Canadian medical schools is not known Methods: All 17 Undergraduate Medical Education Associate Deans of Canadian medical schools were surveyed on the use of SBME at their respective schools. The survey consisted of a combination of yes/no, multiple choice, and Likert-scale questions. Nine out of the 17 schools completed the survey for a response rate of 53%. Survey results were collected between March 21, 2017 and March 21, 2018 Results: Rich data highlighted all aspects of simulation revealing uubiquitous use in multiple domains. Higher fidelity simulation was commonly associated with team, communication and interprofessional competency-based outcomes. Medium to lower fidelity simulation was more commonly associated with formative learning experiences and procedural skill competency attainment. Schools have begun to use simulation for summative assessment in the new era of CBME. Most agreed that learners should have proficiency via simulation prior to clinical exposure and all agreed of its importance to highlight IPE team work and collaboration. Conclusion: This study may help guide curriculum choices for Canadian medical schools as they develop experiential learning. Respondents highlighted task trainers/hi-fidelity simulators and simulated patients as future development areas in their curricula., Background/Purpose: Memorial University introduced formative peer assessment into the undergraduate medical education curriculum and adopted Dannefer et al's (2005) professional competence scale. Applying the Norcini et al., (2018) framework for good assessment, we evaluated the use of peer assessment in undergraduate medical education. Methods: A preliminary survey of medical students' perceptions of peer assessment indicated broad support for anonymous feedback, from peer learning groups, with use restricted to formative and not summative assessment. Students were assessed anonymously by peer learning groups and received peer feedback on four occasions during pre-clerkship phases. Students were surveyed on their satisfaction with the program. Results: 2756 peer assessments were collected, evaluating 241 students from 3 classes over 4 stages of training. Factor analyses validated Dannefer et al's original professional competence scale and interclass correlations demonstrated strong reliability with 6 or more peer raters. However, assessment items display strong ceiling effects that limit the utility of this scale to chart formative improvement. Students were satisfied with the scale's ease of use, but expressed uncertainty about the educational effects of peer assessment or ability to catalyze professional improvement. Conclusion: Peer assessment introduces students to the process of evaluating one's peers and fosters engagement in reflection on professionalism qualities. However, Dannefer et al's professional competence scale may be limited as a tool for longitudinal monitoring of professional competence development and formative improvement. Practical limitations existed in second year where small group size may have impeded peer assessment reliability and anonymity., Background/Purpose: Professionalism competence is a requirement in Canadian Physical Therapy entry-to-practice standards. The UBC Master of Physical Therapy (MPT) Program professionalism curriculum has evolved; though, student engagement in these courses is limited and professionalism concerns on clinical placements continue to rise. The aim of the “Escape Room” was to provide an engaging 'gamification' of critical curriculum in an innovative learning opportunity. Summary of the Innovation: A pilot “Escape Room” activity was run with 12 volunteer MPT students in collaboration with UBC's Theatre Department. Two student groups worked to complete a discharge plan while moving through three rooms staged to represent different settings (e.g. hospital room, charting room) with standardized patients. The students worked together to uncover clues during each time-limited interaction. Students targeted issues of professionalism, scope of practice, conflict resolution and ethical decision-making. Conclusion: Students completed questionnaires immediately after the “Escape Room” activity. Overall, the feedback was positive; students indicated they were engaged through this novel approach to demonstrating their professionalism competence and felt encouraged to be more creative, compared to examination situations. The staging of the rooms was realistic and the actors were well-trained, which further encouraged authentic interactions. Constructive feedback suggested that smaller groups are preferred, a “prize” would increase 'gamification', and clarification of team member roles would improve the experience. This activity provided a successful and engaging approach to practicing and demonstrating professional competencies., Background/Purpose: Tacos with Teachers, a collaboration between the Center for Professionalism and the Office of Institutional Diversity, Inclusion and Equity, is an activity where learners and junior faculty meet with respected Baylor faculty members for informal small group conversations that provides learners with insight on how senior faculty find meaning in their careers, what keeps them connected to the joy in their work and strategies behind their disappointments and success. These breakfasts allow learners to hear the stories behind our most successful and senior faculty as they openly share challenges they have faced throughout their careers. Summary of the Innovation: Faculty members from diverse academic and personal backgrounds were identified as role models and invited to lead a session, which includes breakfast tacos for limited participants to guarantee an intimate setting and accessibility to senior faculty. Response to the sessions has been positive, as found through an anonymous survey. 94% felt the faculty gave valuable advice on managing adversity based on their experiences. 93% felt there was appropriate opportunity to ask the faculty teacher questions. 90% felt the teacher gave useful advice for how to manage one's personal like while still pursuing one's passion. 100% reported they would recommend this activity to others. Conclusion: This activity helps build a sense of community among the learners and the Faculty. Attendees appreciate the insights that senior faculty offer on resilience and work-life integration, and have found the sessions very valuable in setting realistic expectations for themselves and gaining wisdom from their “elders.”, Background/Purpose: For patients living with advanced cardiac illness, treatment options are increasingly complex. University of Toronto (U of T) cardiology residents have no formal teaching on serious illness communication despite the expectation of competency related to goals of care discussions. Family physician clinician teachers with fellowship training in Palliative Care (PC) are uniquely suited to teach communication as a skill. Summary of the Innovation: A new serious illness communication skills curriculum, including a 3-hour workshop with standardized patients, was piloted with four first-year U of T cardiology residents and led by two PC clinician teachers. Residents were asked to commit to practicing one skill learned in the workshop in clinical practice and will receive follow-up coaching by email. Curriculum development was informed by knowledge transfer and deliberate practice theory, and this guided the selection of skills and teaching methods from VitalTalk, an evidence-based communication curriculum. Conclusion: Residents completed a pre-workshop needs assessment survey indicating they had only 'sometimes' or 'rarely' been observed leading family meetings. In the post-workshop survey, all residents 'strongly agreed' that explicit labeling of communication skills and facilitated reflection during role play helped them learn. All residents agreed they would recommend the workshop to other cardiology residents. Future work will focus on recruiting cardiologists as co-facilitators, which would allow for direct observation of resident communication skills in clinical settings. This project highlights a unique opportunity for family physicians and specialists to collaborate in medical education, and also to reflect on teaching competencies across disciplines., Background/Purpose: Despite increasing interest in leadership education for physicians, there is a lack of information regarding what contributes to the credibility of instructors. Understanding the perceptions of learners would be helpful in selection and training of instructors, and may improve program outcomes. Methods: A program evaluation survey which included questions about factors affecting instructor credibility was sent to 89 participants from 8 cohorts of an online faculty development course in medical leadership. Descriptive statistics were used to summarize the data, and narrative comments were analyzed thematically. Results: 28 subjects completed the survey. Qualifications for leadership instructors rated most highly (very important or essential) were content expertise related to work experience (84%) and formal leadership experience (71%). Less important were medical degrees or degrees in administration (e.g. MBA). Having a PhD in medical education or another field was considered relatively unimportant. Narrative comments supported the findings above, and additionally emphasized that credibility was influenced by instructor behaviors, such as responsiveness, asking probing questions, and making insightful contributions to the discussion boards. The value of including instructors from a variety of backgrounds was also mentioned. Conclusion: Participants completing an online faculty development course on leadership rate expertise and experience (particularly leadership experience) more highly than academic credentials when assessing instructor credibility. These findings are currently being used to inform instructor recruitment for leadership programs at our school., Background/Purpose: Leadership is recognized as an important aspect of a competent physician and has been incorporated into multiple physician competency frameworks. However, the understanding of what physician leadership entails within the medical context remains uncertain and varied. The purpose of this study was to explore health care professionals' perceptions of physician leadership. Methods: This qualitative descriptive study used semi-structured interviews to explore interdisciplinary health care teams' perceptions of physician leadership with regards to character, competence, and commitment. All interviews were audio-recorded, transcribed and a qualitative latent content analysis of the transcripts was conducted. Results: A total of 20 interviews were conducted with physicians (n=5), a nurse practitioner (n=1) and allied health members (n=14) within the division of nephrology. Participants identified many traits they deemed to be important to effective physician leadership including a physician's commitment, competence and character, in particular, collaboration, accountability and humanity. A lack of character, in particular, a lack of integrity, humility, humanity, were deemed to contribute to ineffective leadership, along with a lack of commitment and a lack of competence. Conclusion: This research has demonstrated that health care professionals believe that character, competence and commitment all play a vital role in effective physician leadership. In the era of competency-based design, identifying the perceived value of character and commitment in addition to competency with regards to effective physician leadership provides unique insights with implications for medical schools admission processes, undergraduate and postgraduate medical curricula (both formal and hidden) and ongoing professional development., Background/Purpose: Selon les principes de responsabilité sociale, les facultés de médecine ont maintenant l'obligation de former les futurs professionnels de la santé à agir de façon adéquate dans la société et à collaborer pour réformer le système de santé afin qu'il soit pertinent, de grande qualité, efficient, équitable et durable au bénéfice des communautés locales, du pays et la communauté internationale. Mais qu'est-il attendu concrètement qu'un étudiant développe comme compétences particulières à cet égard? Actuellement, les profils de compétences plus génériques (ex. CanMEDS) ne sont pas assez détaillés en matière de responsabilité sociale pour permettre aux programmes de bien cibler sur quoi agir pour former des professionnels plus socialement responsables. Summary of the Innovation: Pour répondre à cette question, la Faculté de médecine de l'Université Laval a organisé trois forums citoyens, dans trois régions différentes du Québec, afin de co-construire avec les citoyens le profil de compétences du professionnel de la santé socialement responsable. À l'aide d'une approche de type world café, les citoyens ont identifié des éléments de compétences qu'ils jugeaient « socialement responsables » à partir de situations qu'ils avaient personnellement vécues. Une analyse qualitative de contenu a ensuite été menée afin de regrouper ces éléments et proposer un profil de compétences spécifique à la responsabilité sociale. Conclusion: Le profil de compétence du professionnel socialement responsable proposé est composé de sept thèmes : 1) intelligence émotionnelle et sociale 2) partenariat avec l'usager 3) collaboration interprofessionnelle 4) pensée systémique de la santé 5) pensée systémique de gestion 6) ancrage dans le milieu 7) éthique et engagement social., Background/Purpose: The adoption of telemedicine in healthcare has lead to an increased need for training programs for physicians, medical students, and other clinicians who use telemedicine to provide patient care. Challenges related to affective distance, remote body, and the transformation of sensory perceptions can make a clinical diagnosis more challenging. Most online training programs focus on technological skills rather than communication and relational skills, which are fundamental to putting patients at ease. There is a gap in the development of online training programs focused on these skills. Summary of the Innovation: In a previous study, we analysed patient/doctor interactions during teleconsultations and reported specific communication strategies and relational skills used by physicians to conduct a remote clinical exam. Based on these results, we are designing an online training program that cover two sets of skills: (a) relational skills to establish a sense of connectedness with the patient and (b) communication skills to compensate for the lack of physical contact. To properly address these skills, we are developing a multimodal learning environment that allows instructional elements presented in more than one sensory mode (visual, auditory, written). The use of multimodal resources is a powerful way to facilitate reflection in and on action for improving relational and communication skills. Conclusion: The design of an online training program integrating multimodality in a virtual learning environment supports 'reflexivity-in-practice' and provides practical tips for health care providers to communicate effectively with patients during a telemedicine consultation., Background/Purpose: There is an increasing need for palliative care services and training as the aging population continues to grow along with progress in medical technology. We designed, implemented and evaluated an innovative workshop to advance 4th year medical students' palliative care skills. Summary of the Innovation: We offered a day-long workshop to fifty 4th year medical students with the goal of enhancing their communication skills with patients with advanced illness, families and an interdisciplinary team. The curriculum was hands-on, case-based and uniquely structured by immediate, individualized, and real-life feedback from professional actors, interdisciplinary faculty, and a bereaved family member until students demonstrated the core competencies modified from the American Academy for Hospice and Palliative Medicine. Cases included patients of all ages in varying life-threatening situations. We administered pre-, post- and second post-workshop surveys, asked students to report critical learning points, analyzed quantitative survey data, and performed qualitative thematic analysis via inductive open coding. Students reported increased comfort levels with understanding and utilizing palliative care skills and processes and personal qualities for communicating with patients, families and healthcare teams. Students reported having practiced these skills during clinical rotations after the workshop. Conclusion: Participating students advanced their palliative care skills and gained insights on personal qualities that health care professionals must adopt to communicate appropriately with patients, families and healthcare teams. Since our pilot study yielded promising results, up-scaling and further evaluation of this innovative workshop can potentially lead to a standardized curriculum for medical students nation-wide., Background/Purpose: The Truth and Reconciliation Commission recommendations on health call for the provision of cultural competency for all health-care providers. The UBC Faculty of Medicine has implemented an Indigenous standardized patient session as part of the Year 4 curriculum in order to ensure that students are able to demonstrate cultural safety in a clinical scenario. Summary of the Innovation: The standardized patient sessions are lead by health care practitioners with an interest in Indigenous Health. These leaders practice cultural safety themselves, and are able to lead rich discussions on Indigenous health. A critical aspect of the session is that the standardized patients are female community members who authentically represent an Indigenous patient, and are therefore able to elicit holistic and relational health care concerns that are challenging to address in typical medical school curricula. The session also facilitates a process of recruiting instructors interested in helping students practice cultural safety. In order to build a sustainable environment for delivering TRC recommendations, the Faculty of Medicine aims to recruit and retain Instructors and Faculty versed in Indigenous health, who are best positioned to engage students and impart their knowledge to the current faculty. Conclusion: The 2019 session was highly rated by the medical students in terms of attaining knowledge and skills for practicing cultural safety. The 2020 session will evaluate the student's ability to practice cultural safety by the standardized patients, Background/Purpose: Gender diverse patients need to be heard. Historically treated through a psychiatrist's lens, they are underserved in health care, facing significant disparities like higher rates of poverty, homelessness, unemployment, depression, and substance use. Physicians play an important role. When providers offer non-judgemental and knowledgeable care, gender diverse patients are more likely to continue seeking medical recommendations. A capacity for listening is integral to a gender-affirming, trauma-informed, and patient-centred approach to care. Summary of the Innovation: UBC CPD partnered with Trans Care BC to develop a Gender-Affirming Primary Care online educational training series. Key areas of the first module were identified as appropriate for patient stories (based on topic, availability or personal accounts, and patient-perceived impact on care). To balance a learner-centred approach with patient authenticity, stories were collected through patient interviews, synthesized, and patient-validated. Custom patient-centred interview protocols and evaluation templates streamlined medical concepts, effectively capturing patients' input. Finally, patient volunteers lent their voices to the audio stories embedded in the education alongside scripted text. Learners are encouraged to read and listen to the recordings simultaneously - creating a more immersive learning experience that caters to different learning preferences. Conclusion: Patient stories are often considered extraneous in medical education. Even when included, they are developed as an afterthought, which consequently presents the risk of appearing tokenistic. However, when co-developed with patient input, stories can empower patients, enable physicians to practice managing sensitive discussions, and provide an avenue for impacting care through real-life examples of what is meaningful to patients., Background/Purpose: Le terme générique « Patients impliqués en éducation des professionnels de la santé » (PIEPS), utilisé ici, regroupe les patients partenaires, les patients simulés et les patients standardisés qui participent aux différents contextes d'apprentissage et d'évaluation des compétences cliniques des futurs professionnels de santé dans le cadre des études médicales. Les PIEPS sont souvent peu informés de ces divers contextes et peu formés pour répondre aux exigences attendues. Ce projet vise à décrire les compétences requises pour être un PIEPS, et à identifier les besoins de formations spécifiques pour chaque groupe de PIEPS. Methods: Des entrevues téléphoniques semi-structurées et des groupes de discussion ont été menés auprès de 25 PIEPS ayant au moins 3 années d'expérience, puis transcrits, analysés et codifiés à l'aide de Nvivo pour extraire les thèmes émergents. Results: 5 patients partenaires, 10 patients simulés et 10 patients standardisés ont participé. Les compétences de communicateur et de professionnalisme sont essentielles pour les 3 groupes de PIEPS qui expriment le besoin d'une formation de base décrivant leur place en éducation. Les patients simulés et standardisés ont besoin des compétences d'interprétation du scénario clinique et les patients partenaires des compétences relationnelles pour partager leur savoir expérientiel. Conclusion: Les participants de cette étude ont identifié des compétences essentielles pour accomplir leurs tâches de PIEPS. Ils suggèrent une formation structurée sous forme de mentorat pour maximiser leurs compétences et les orienter au sein du cursus des études médicales., Background/Purpose: The Center of Excellence on Partnership with Patients and the Public (CEPPP) with the Collaboration and Patient Partnership Unit (CPPU) of University of Montreal launched in 2019 an online post graduate (masters) course named Fundamentals of Patient Partnership. This course is composed of 12 interrelated themes from various disciplines and was co-developed with over 20 content experts and patients. This complex interdisciplinary structure called for a differing pedagogical approach to each theme. Summary of the Innovation: The objective of the team was to convey the essence of each disciplinary field. This required the recognition that a given pedagogical approach is never neutral (Bernstein, 2000). Therefore, the development team worked with the premise that the pedagogical framework (ex: structure of objectives, skills, evaluation, etc.) suggested by the content experts from a given field was the most appropriate for teaching that field. The assumption was that content experts know best how to teach their discipline. The pedagogical framework for each theme was determined through discussions between the development team and content experts, during which the pedagogical framework would gradually emerge. Conclusion: This pedagogical design approach was later formalised during the development of a training program destined for patients accompanying other patients suffering from similar illnesses in healthcare establishments across Quebec. We present the CEPPP and CPPU's methodology for pedagogical design in partnership with patients., Background/Purpose: In 2017, the United Nations reported 68.5 million individuals forcibly displaced worldwide as a result of violence or conflict. Increasing refugee population has led to changes in the provision of healthcare. Historically, health care providers have not received targeted training in refugee health (RH). There has been a worldwide interest in developing educational opportunities for medical students in RH. The aim of our work was to identify and analyze currently existing literature on educational content and methods of delivery in UME curricula related to RH. Methods: We conducted a scoping review. The search strategy was restricted to English language and scholarly articles. Search was conducted in seven electronic bibliographic databases. Three members of the research team tabulated and summarized the extracted data. Descriptive thematic analysis was used to present the findings. Results: Of the 717 publications found, 26 met inclusion criteria. All were published between 2003-2019. Fifteen (57.6%) were descriptive papers, 3(11.5%) qualitative, 4(15.3%) quantitative and 1(3.8%) mixed methods. One commentary, 1 letter to editor and 1 review paper. Four descriptive themes were identified: 1) Content related to refugees' 2) Educational strategies 3) Learning outcomes and 4) Recommendations. Conclusion: Including content on RH in the undergraduate medical curriculum, delivered in active learning, small group methodology, and partnering with community resulted in improved students' clinical skills, communication and knowledge. Systematic and longitudinal inclusion of the topic is recommended to provide effective care delivery for this vulnerable population., Background/Purpose: In 2016, Service Learning became a curricular requirement for undergraduate medical students at the University of Manitoba. Since that time, significant feedback has been collected from students re: their Service Learning experience. While many community contacts who work with these students regularly provide informal feedback to the university, this survey collected systematic feedback from community partners involved with Service Learning. Methods: In June 2019, a survey was distributed to 36 organizations to seek feedback about their experiences working with Service Learning students. Participation in the survey was voluntary. In total, 27 organizations participated. Results: Respondent feedback could be grouped into two main themes: Logistics, and the Service Learning Experience. About half (52%) indicated it was “easy” to schedule students for Service Learning; however, students' busy schedules and differences between hours of organization programming and students' availability were identified as considerations. Most respondents described students as “engaged” (70%) or “somewhat engaged” (26%) in their Service Learning experiences. Sixty-eight percent of respondents indicated Service Learning raised students' understanding of power and privilege, and systemic oppression. Conclusion: Seeking feedback from community partners involved with Service Learning provided valuable insights to inform and improve the Service Learning program. Results identified specific areas of the program and logistic improvements to be addressed moving forward. Ensuring processes are in place to obtain feedback from community organizations is an important step to strengthen reciprocal, working relationships between university and community organizations. Doing so enhances the Service Learning experience for both students and community partners., Background/Purpose: Canada's rural populations are dramatically underserved by family physicians.Traditional medical education exasperates this problem by funneling the majority of graduates into urban specialty practice. Longitudinal integrated clerkships may be one way of improving recruitment to rural generalist practice. Our study aimed to determine if students from the rural Integrated Community Clerkship (ICC) at the University of Alberta were more likely to be in family medicine and/or in rural practice locations than those in the rotation-based clerkship (RBC). The rural ICC program is a 40-week 3rd year clerkship with students learning the core disciplines of medicine in an integrated clinic- and hospital-based comprehensive rural family practice. Methods: Using the U of A graduation lists from 2009-2016 and public databases, current practice locations and final career choice for all graduates were compiled. Results: We examined outcomes for 834 RBC graduates and 124 ICC graduates. The RBC graduates were more likely to establish urban practices (87% vs 13% rural); whereas ICC graduates were equally likely to establish urban and rural practices (51% vs 49%). RBC graduates were split between family medicine (48%) and specialty practice (52%); whereas ICC graduates were more likely to be in family medicine (78%) than specialties (22%). Overall, ICC students were 3.8 times more likely to establish a rural practice compared to RBC graduates. Conclusion: Seven years of data suggest that the longitudinal integrated clerkship is effective in increasing the numbers of rural family physicians and contributing to improving health service delivery for rural communities., Background/Purpose: Doctors require exemplary communication skills and the right attitude to care for the growing number of elderly patients. Early exposure to the elderly in medical courses has been shown to help change student attitudes and challenge thinking in stereotypes. Summary of the Innovation: The SCPP runs for the duration of the MBBS course and aims to introduce students to 'healthy ageing'. Two students are partnered with a senior citizen residing in a retirement facility. The students meet their senior partner a prescribed number of times, forming a partnership rather than viewing them as a patient. During these encounters students enquire about social, psychological, environmental and health impacts on the life of the senior, while practicing communication skills taught in clinical skills. Students also attend debriefing sessions and submit reflections about their encounters addressing relevant learning objectives using a reflective framework. Data collected from debriefing sessions, students´ assignments and focus groups demonstrate an increased awareness about the elderly generation, acknowledging that previously held stereotypes and reservations were challenged. Students recognise the diversity in this population and the individual needs of seniors, relevant to them as future doctors. The interaction allows students to overcome initial hesitations to approach the elderly, and fosters relevant communications skills by providing authentic experiences. Surveys conducted at the retirement facilities emphasise that the senior partner benefited from the interaction on many levels. Conclusion: A programme which enables students to foster a trusting partnership with elderly people during early exposure in a medical course can help to change the attitudes of medical students., Background/Purpose: It is important for residency candidates to have an understanding of the weight that residency programs give to scholarly activities. Residency program descriptions in the Canadian Residency Matching Service (CaRMS) website were reviewed to determine whether scholarly activities were mentioned as a selection criterion. Methods: 2019 CaRMS published program descriptions were reviewed for internal medicine, family medicine and pediatrics in all 17 Canadian faculties of medicine. Residency programs that mentioned “scholarly activities” or similar descriptors such as “applied health/clinical research”, “quality improvement” or “education research” in their descriptions were identified. Results: Forty-one percent of the family medicine, 65% of the internal medicine and 71% of the pediatric residency programs explicitly stated having interest in applicants with scholarly activities. In Western Canada, 80% of the internal medicine programs and 60% of the pediatrics programs included scholarly activity in their CaRMS description of criteria considered in ranking applications. Similarly, in Ontario, 66% of the internal medicine and 83% of the pediatrics residency programs mentioned scholarly activity as a desirable accomplishment. In Quebec 100% of the family medicine and 50% of the pediatrics programs include scholarly activity in their descriptions. Conclusion: Students can use data from this study to prioritize their activities to include scholarly work during their undergraduate MD training in order to be as competitive as possible for application to specific residency programs in family medicine, internal medicine and pediatrics. The authors recommend CaRMS website descriptions explicitly list selection criteria for residency programs from all of the CanMEDS physician competencies including scholarly activities., Background/Purpose: There is a developing international transition to competency-based medical education (CBME) in undergraduate and post-graduate medical training. Competencies define measurable skills and behaviours that are expected of medical students and residents and are attained through a series of stages or milestones throughout training. Canadian medical education competencies, particularly foundational medical science competencies, are under-reported. We here report - and demonstrate the clinical significance of - competencies for a foundational medical science at the medical school at the University of British Columbia. These examples of clinically mapped competencies will be of interest to, and useful for, educators who are teaching in, exploring, or implementing competency-based medical (and allied health fields) curricula. Summary of the Innovation: Medical schools across Canada have recently developed and embraced CBME curricula at both the undergraduate and post-graduate levels. Many of the Canadian competencies for post-graduate clinical specialties have been described and/or published, but undergraduate foundational medical sciences competencies remain under-reported. It is important to bridge this gap in order to allow integration of competencies across the continuum of undergraduate medical education to post-graduate clinical training. We have bridged this gap through the development of an alignment and mapping of undergraduate foundational medical science competencies to post-graduate clinical skills and scenarios. Conclusion: We here provide a novel description of the generation and use of milestones and competencies in a core undergraduate foundational medical science (histology) at a Canadian medical school. Significantly, by framing our competencies with exemplars, we clearly and uniquely demonstrate how each of our foundational medical science exit competencies can be mapped to clinical scenarios that both medical students and physicians will encounter., Background/Purpose: Distributed medical education has been increasingly prominent on the Canadian medical education landscape with the development of distributed rotations, longitudinal clerkships, and family medicine programs. A survey of distributed specialty medical education programs in Canada is not yet available. The current research seeks to remedy this deficiency. Methods: CaRMS advertisements (2018 R1 match) were evaluated for separately advertised distributed streams. Program directors and/or site leads were identified for each stream. A survey inviting comment on the strengths and the challenges of these programs was circulated. In addition, a cohort of residents matched to distributed streams (2009 - 2012) were identified and practice locations determined using CAPER data for 2018. The odds ratio of graduates of these programs compared to residents from the main programs practicing in settings other than large cities was calculated. Results: Twenty-two separate streams were identified matching 45 residents (1.4% of matched residents). Psychiatry was the most popular program (10/22). Strengths of distributed programs included the wealth of learning opportunities at these sites along with the ability to provide the requisite learning. The challenges identified focused mostly on the difficulty in engaging faculty regarding committee work and formal academic teaching. The odds ratio of graduates of distributed programs practicing in locations other than large cities when compared to residents trained in the main program was 3.77. Conclusion: Distributed specialty residency education still accounts for a very small number of residents trained in Canada but is promising as a way of encouraging practice in distributed settings., Background/Purpose: L'efficacité de la formation décentralisée pour l'installation des finissants en région rurale est bien documentée et son apport économique est aussi mieux connu. Il s'avère que l'impact de formation décentralisée sur les différents acteurs en région est moins documenté dans la littérature. Dans le contexte de l'augmentation de la charge clinique et des pressions gouvernementales sur les réseaux de soins, il nous apparaît prioritaire de mieux documenter les impacts dans ce contexte. Methods: En 2016, à l'aide d'un sondage en ligne auprès de 1200 professionnels, administrateurs et médecins enseignants, nous avons cherché à documenter les perceptions des acteurs locaux sur 4 dimensions: l'équité, les effets non recherchés, la faisabilité et l'acceptabilité de la formation décentralisée. Le cadre d'analyse des politiques publiques de Morestin nous a servi de modèle. Six milieux de formation en région offrant chacun plus de 100 périodes de stages par année de niveau externat et résidences ont participé au sondage. Results: Nous avons obtenu 301 répondants, dont 76 % étaient impliqués dans l'enseignement. Les perceptions négatives de l'enseignement sur le milieu étaient faibles, ex: la sécurité des soins (12 %), qualité des soins (10 %). Les perceptions d'effets favorables étaient nombreux et majoritaires pour le développement des compétences (78 %), le recrutement médical (68 %), le développement de l'interdisciplinarité (68 %), la satisfaction au travail (61 %) . Finalement, 81 % des répondants considéraient que globalement l'enseignement médical avait des retombées positives dans leur milieu de travail. Conclusion: Les perceptions de l'enseignement médical par les acteurs en région qui ont répondu au sondage sont majoritairement positives. Des effets non directement recherchés comme le développement de l'interdisciplinarité et de la compétence des acteurs du milieu sont des avantages indéniables. Les perceptions plus partagées des impacts sur l'acquisition de ressources financières et équipement devraient éveiller notre réflexion. Des sondages plus courts augmenteraient probablement le nombre de répondants. Les impacts sur l'interdisciplinarité, la qualité et la sécurité des soins sont des sujets intéressants à approfondir dans l'avenir., Background/Purpose: There are increasing pressures on the Canadian healthcare system to provide quality care in the face of an aging population and growing rates of chronic diseases, all while managing escalating costs. To stimulate development of innovative solutions to achieve better health outcomes and optimize the cost of delivering care, healthcare systems in Canada (and in Europe) are beginning to leverage innovation procurement strategies (IPS). Unlike traditional procurement that focuses on providing a solution at the lowest price, in IPS, the procuring organization focuses on understanding the problem, identifying who would be impacted, and defining health outcomes to be achieved. However, the newness of IPS means that few healthcare professionals (HCPs) have the required training to participate in IPS. Methods: To understand the educational needs of Ontario HCPs, we used a grounded theory approach. Semi-structured interviews were conducted with 33 HCPs, Ontario health agencies and procurement centres with varying experience in IPS. Transcribed interviews and focus groups were analyzed using thematic design. Open coding was used to allow themes to emerge from the data. Results: Three overarching themes emerged: IPS processes, building IPS capacity, and supports and resources. From these themes, an IPS clinical framework was developed. The framework includes five components: health innovation culture, IPS process mechanisms, internal supports and resources, and external supports and resources involving vendors/industry and procurement experts. Conclusion: This IPS clinical framework can be used as a foundation for healthcare agencies wanting to engage in their own IPS, and adds to the dearth of literature in this field., Background/Purpose: Depuis quelques années, l'approche du partenariat de soins s'établit comme étant une référence en pédagogie, en recherche, en gestion et dans les soins. L'évaluation des compétences des étudiants et des soignants par des patients prend elle aussi de plus en plus d'importance en pédagogie et dans les milieux de soins. Summary of the Innovation: La Direction collaboration et partenariat patient (DCPP) de l'Université de Montréal travaille depuis quelques années à l'intégration des patients partenaires en évaluation des compétences des étudiants en médecine et en sciences de la santé. Ce processus nécessite une démarche rigoureuse débutant par le recrutement des patients, leur formation aux fondements du partenariat de soins ainsi que leur formation à l'évaluation des compétences concernant entre autres la posture à prendre en évaluation ainsi que l'utilisation des différents outils d'évaluation. Afin d'illustrer la démarche d'intégration des patients partenaires en évaluation, nous donnons l'exemple de l'examen de reprise ou de remise dispensé aux étudiants de médecine en fin d'externat, depuis les raisons et les circonstances qui ont permis cette innovation pédagogique, le processus de recrutement des patients jusqu'à l'évaluation des étudiants lors de l'examen. Conclusion: Les différentes étapes du processus d'intégration des patients partenaires en évaluation sont importantes afin d'appuyer la démarche et ainsi permettre une expérience optimale pour tous les acteurs., Background/Purpose: Increasingly, postgraduate trainees are in search of additional training to enhance their roles as Scholars. Traditionally medical education tracks have been limited to individual training programs which does not promote collaborative practice across a diverse range of specialties. Emory's Medical Education Residency Track (MERT), is an 18-month program, designed for multidisciplinary trainees to gain competencies essential to becoming medical educators. Summary of the Innovation: MERT is distributed into three phases: Principles of Scholarly Teaching, Medical Education Scholarship, and Scholarly Project. Sixteen trainees from 11 residency/fellowship programs applied for the 2018-2019 cohort. Eleven were accepted and 10 (91%) completed Phase 1. Phase 1 involved adopting Kolb's experiential learning model to support trainees' learning through peer teaching. As part of a longitudinal, formative evaluation, we used descriptive statistics and content analyses of survey data to explore the effectiveness of Phase 1. Strengths of Phase 1 included opportunities for group discussions and interactive team work activities. Residents also reported being able to apply skills from sessions about Teaching & Facilitating Learning (70%), Learning Needs & Outcomes (50%), Bed- & Bench-side Teaching Strategies (50%), and Feedback & Contemporary Feedback Models (50%). Resident examples of applying skills in their settings included “Using 1 min preceptor with interns on my service”, “utilized Kahoot! during my lectures with Med tech students”, and “establishing learning needs and outcomes”. Conclusion: Adopting an innovative peer teaching aspect coupled with using Kolb's 4-stage model not only reinforces learning, but also creates a cadre of future medical educators in a “train-the-trainer” type model.

Background/Purpose: Physician report cards are an important aspect of outcomes-based practice and education. Therefore, we investigated how data collected from the electronic health record (EHR) could assess emergency medicine (EM) residents' independent and interdependent clinical performance and how such information can be appropriately represented in an EM resident report card. Summary of the Innovation: Cerner EHR data were collected from 2017-2018, representing approximately 150,000 patient visits to the Emergency Department and 850 patient encounters, for one randomly selected fifth-year EM resident. A fifth-year resident was used for developing our prototype because we anticipated this performance level affords the best opportunity to look at both independent and interdependent metrics. Once we extracted all EHR data for our randomly selected resident, we developed an EM resident prototype report card that compared the resident's performance to faculty/other residents' performance. Our prototype breaks down EHR data by blocks, which better aligns with the rotation schedules of residents. Depending upon the metric (e.g. number of patients seen, bounce-back rates, or time to fluids/antibiotics), resident data were compared to faculty or year-appropriate residents'. Each metric was accompanied by an explanation of the metric and designation of independent or interdependent based on earlier interviews with faculty and residents. Finally, we present our development timeline and the resident prototype report card. Conclusion: Our findings document a process for developing resident report cards that incorporates the perspectives of clinical faculty and residents. This work has important implications for capturing residents' contributions to clinical performances by distinguishing between independent and interdependent performance., Background/Purpose: CBME is a global phenomenon that is radically influencing Canadian Residency Education. While the community is actively discussing CBME implementation, they have yet to agree on its underlying philosophy and principles, resulting in misinterpretation and miscommunication in these discussions. This study explored the perceptions of diverse key stakeholders regarding the philosophies, principles and implications of CBME in Canada. Methods: Researchers identified CBME designers and scholars from diverse perspectives, geographies and professional roles, using snowball sampling after each interview. Transcripts were analyzed with iterative inductive thematic analysis. Initial coding was established with a subset of transcripts by 2 researchers and themes were further developed by the full team. Results:17 semi-structured interviews were conducted between September and November 2018. Five recurrent areas of disagreement and/or confusion were identified: Problems with the traditional education model CBME was intended to solve; Philosophies; Principle; Practices; and Unintended Consequences. In addition, it should be noted stakeholders cited different literature and framed their conversations differently. The results highlighted variations in the way CBME is conceptualized, underscoring the need for this conversation, and identified opportunities to improve the way conversations regarding CBME occur. One participant noted that “Common language is useful, but requires trust.” Conclusion: This study highlighted areas of discrepancy and overlap regarding the overarching intent, philosophies and principles of CBME. These initial insights may enable discussions on how to use our areas of agreement and discrepancy to inform more productive conversations and better implementation of CBME. Evident from the interviews, participants wanted to have this discussion., Background/Purpose: With competency based medical education (CBME), entrustable professional activities (EPAs) are used to evaluate residents on performed clinical duties. This study aimed to determine if implementing a case-based discussion, designed to increase recognition of available EPAs, into CBME orientation would help residents increase the number of EPAs completed. Methods: We designed an intervention consisting of clinical cases that were reviewed by national EPA experts who identified which EPAs could be assessed from each case. A case-based session was incorporated into the 2019 CBME orientation where Postgraduate Year (PGY)1 residents read the cases and discussed which EPAs could be obtained with PGY2/faculty facilitators. The number of EPAs completed in the first two blocks of PGY1 was determined from local program data. Student's t-test was used to compare averages between cohorts. Results: We analyzed data from 22 trainees (7 in 2017, 8 in 2018, and 7 in 2019). In the first two blocks of PGY1, the intervention cohort (2019) had a significantly higher average number of EPAs completed per trainee (47.4 [SD 11.8]) than the pre-intervention cohort (25.3 [SD 6.7]) (p, Background/Purpose: Competency-based medical education (CBME) has emerged as a new curricular paradigm focused on ensuring that post-medical education graduates are competent to meet patients' needs. As residents are key participants in this educational model, their engagement is key to successful implementation. We explored the perceptions and experiences of residents in Canadian training programs that have implemented CBME. Methods: Using constructivist grounded theory, we conducted semi-structured interviews with residents training in family medicine and other specialty residency programs. Our resident-led team developed and refined an open-ended interview guide which explored trainee experiences with CBME. Themes were co-constructed alongside our own experiences of CBME using a constant comparative analytic approach. Results: Residents expressed receptivity towards the goals of CBME but described many challenges to how they experienced these goals in practice. CBME assessments were felt to include a subjectivity of ratings and competence decisions, leading residents to adopt insincere behaviors. Learners described the administrative burden of assessment as overshadowing clinical duties and contributing to both burnout and feelings of anxiety regarding academic progression and professional success. Participants expressed that engaged and supportive faculty had a positive impact on their CBME experiences. Conclusion: As CBME implementation continues across Canada, we hope educators and residents alike can benefit from this rich, mixed methods evidence on the challenges and opportunities trainees face in their educational experience. Resident perceptions should continue to be explored as a measure of CBME effectiveness and lessons learned should be applied to future initiatives., Background/Purpose: Queen's University implemented competency-based medical education (CBME) across all 29 programs on July 1, 2017. The purpose of this study is to describe key stakeholders lived experiences in CBME Foundation of Discipline stage in the Ophthalmology department. Methods: Using a case study approach, a mixed method rapid-cycle evaluation was conducted during the 2018-2019 academic year. The evaluation consisted of two evaluation cycles with the first round of interviews and focus groups occurring in October 2018 and in March 2019. Residents, faculty, academic advisors, competence committee members, program director, program administrator, and the educational consultant were interviewed. Recommendations were implemented in January 2019 and June 2019. Results: Stakeholders identified the need to build a shared understanding about how to both trigger assessments and encourage all faculty members to engage in the process. Stakeholders also described how their roles continued to evolve following CBME implementation. Participants discussed how the department functioned and would continue to build understanding about the assessment process. The rapid-cycle evaluation identified the need for streamlining and clarifying specific Entrustable Professional Activities. Stakeholders did suggest a preference for narrative feedback and identified the benefits of the feedback provided. Conclusion: Rapid-cycle evaluation has been a valuable process for identifying key strengths and recommendations following implementation of a new CBME curriculum. Exploring lived experiences resulted in positive and immediate improvements to the residency program. Both the recommendations and evaluative approach will benefit other departments and institutions as they implement CBME., Background/Purpose: Progress testing refers to a form of assessment in which a comprehensive test is administered to learners repeatedly over time. The use of progress tests (PT) is increasingly popular. To inform potential users, this scoping review aimed to document barriers, facilitators and potential outcomes to the implementation of written PTs in higher education. Methods: Arksey and O'Malley's framework was used to identify and summarize the literature on PTs. Six databases were searched. We included articles written in English or French and pertaining to written PTs in higher education. Screening for inclusion criteria was performed by two team members (90% agreement) and then extraction was performed in pairs by the research team. Using a snowball technique additional papers were identified during this process. Thematic analysis was completed through an iterative process. Results: The initial search strategy yielded 338 papers, of which 92 met inclusion criteria. Using a snowball technique, an additional 229 papers were identified and 8 were ultimately included in our analysis. The majority of PTs used the MCQ format and were relatively long (mean 179 items over 190 minutes). Five major themes were identified through thematic analysis: acceptability (e.g., satisfaction with feedback received), facilitators (e.g., collaboration), barriers (e.g., resource-intensiveness), validity evidence (e.g., psychometric evidence) and outcomes (e.g., impact on learning). Conclusion: PTs appear to have a positive impact on learning and there is significant validity evidence to support their use. Although the use of PTs is resource and time-intensive, strategies such as collaboration with other institutions may facilitate implementation. PTs appear to have a positive impact on learning and there is significant validity evidence to support their use. Although the use of PTs is resource and time-intensive, strategies such as collaboration with other institutions may facilitate implementation., Background/Purpose: The shift to CBME places a renewed emphasis on assessment. One challenge in this context is that there are myths that affect the trustworthiness of assessment use and interpretations. By identifying myths, we aim to: 1) improve understanding of diverse components of assessment; 2) raise awareness of how to address multiple interpretations emerging from assessment use; and 3) contribute to better assessment practices. Methods: This presentation draws from a narrative review of the literature in Education and Health Professions Education to identify myths associated with assessment, and uses analogies from Greek mythology to illustrate the underlying misconceptions. Results: Four myths capture assessment misconceptions: • Assessment development: Similar to the ancient Greeks who consulted the Oracle of Delphi to find THE truth, educators falsely hold the belief that there is a single best assessment framework. • Generation of information: Workplace-based assessment mistakenly assumes that raters- like Zeus - know everything about assessment including rating, and generating feedback, because of their clinical expertise. • Feedback: Clinical teachers' assume that feedback always provides enlightenment to learners, just as Prometheus lighted man's world through fire. Unfortunately, learners will not always use feedback as intended. • Decision-making: Assessment using EPAs assumes that entrustment suggests competence. Like Janus, the Greek god that sees simultaneously into the future and the past, entrustability and competence may be two aspects of learners' performance; they are not synonymous. Conclusion: Examining these myths provides an opportunity for assessment users to adopt critical perspectives on assessment, and provides avenues for advancing validation efforts to ensure that uses are supported., Background/Purpose: The CFPC Evaluation Objectives are the basis for FM resident assessment in Canada. These include 99 Priority Topics (PTs), each with their own set of Key Features (KFs). Sufficient sampling of assessment data based on these KFs (n=947) contributes to overall summative decisions about competence and readiness for independent practice. The Calgary FM Residency Program uses 26 EPAs, developed by a Delphi process, to define expected outcomes-of-training. The purpose of this validation study was to map the CFPC KFs to the Calgary EPAs. Methods: A 2-stage mapping process was utilised. Stage 1 involved 2 independent reviewers selecting KFs as the core competencies for each EPA. Stage 2 involved 13 meetings with a small nominal group who reviewed and accepted/discarded the chosen KFs for each EPA from Step 1. As a secondary activity, the group also assigned KFs to different FM Professional Profile (FMPP) categories. Results: The average number of KFs assigned to each EPA was 84 (4-482). The range was 1 to 12 EPAs for each KF; 316 KFs were assigned to one EPA and 1 KF was assigned to 12 EPAs. 69 (“orphaned”) KFs were not assigned to any EPAs. All of the major FMPP categories, except “scholarship”, were represented by the selected KFs Conclusion: This study directly links the CFPC Key Features to a set of training outcomes (EPAs) developed separately by the Calgary FM Residency Program, adding to the validity of KFs as ground-level, observable behaviours that can be assessed and used to make higher-level decisions about competence in Family Medicine., Background/Purpose: Competency-based medical education propelled entrustable professional activities into the spotlight. While research has highlighted factors influencing supervisor entrustment of trainees, there has been less focus on how residents influence their own entrustment. We explored how residents request clinical support and how those requests impact provision of clinical support and subsequent levels of supervision. Methods: We observed and interviewed four attending-resident dyads on internal medicine Clinical Teaching Units (CTUs) at UBC once per week for 2 weeks. Employing case study methodology, we first analyzed the dyadic relationships through a narrative lens. We then identified sentinel incidents to examine requests for and provision of clinical support. Finally, we used help-seeking and entrustment as sensitizing concepts to analyze data within-case, between-case, and cross-case to develop themes. Results: When residents directly requested clinical support, it was provided. When they indirectly asked for support using body language or texting updates about patients, attendings often failed to recognize it as a request for support. The requests did not affect attending's judgment of the resident's competence. Provision of clinical support did not impact subsequent supervision. In fact, evidence of competence judgments impacting assignment of activities or level of supervision was lacking. Conclusion: Residents use various strategies for requesting clinical support with some resulting in miscommunication. Seeking help did not adversely impact judgments of competence or subsequent levels of supervision. However, the link between resident competence and supervision was not obvious and requires further study if entrustment scales are to be used to assess residents on CTU., Background/Purpose: Pursuing efficient assessment of trainees in clinical practice is especially valuable for athletic therapy (AT) as a health care profession transitioning to competency-based education (CBE). Entrustment scales are used as authentic indicators of competence that bridge assessment with supervisors' decisions to grant trainees autonomy in executing specific tasks. To lay the groundwork for developing AT entrustable professional activities (EPAs) and to enhance assessment efficiency, we investigated the entrustment processes described by AT supervisors for appropriate language to develop an AT entrustment scale. Methods: Semi-structured interviews were conducted with 14 AT clinical educators from various Canadian practice environments. We used directed content analysis to extract, describe, and order entrustment processes based on student autonomy. We then mapped criteria from three predominant medical education entrustment scales to the ordered AT entrustment processes and compared language using summative content analysis. Results: In clinic settings, AT students may be permitted to “observe”; replicate the supervisor's actions or techniques; “assist” with a component of patient care; “lead” with periodic supervisor consultation; and “make [patient care] decisions on their own”. These entrustment 'checkpoints' resemble ten Cate's five levels of supervision (2013), although field (sport) autonomy in AT is described with different language. Conclusion: Two entrustment scales reflecting levels of trainee autonomy in the clinic and field settings of AT may act to streamline daily assessment in CBE. Further, compiling entrustment data could aid programs with assigning practicum placements based on site-specific requirements identified by supervisors., Background/Purpose: While entrustment scales (ES) have come into favour in an era of competency-based medical education (CBME), little research exists on how teachers make entrustment decisions using these scales. There is controversy in the literature as to how much faculty development is required prior to transitoning from traditional rating scales to ES. To explore this, we conducted cognitive interviews with teachers who had used a validated ES for family medicine maternity care assessments. We asked the teachers what the anchors meant to them and how they decided when to use them. Methods: We used purposive sampling and conducted 14 cognitive interviews with faculty who had completed at least 2 entrustment-based assessments in family medicine maternity care over the last 6 mos. Interviews were recorded and transcribed. A constant comparison approach was used to code and analyze the data using NVivo 11 until consensus was reached regarding emerging themes. Results: Themes: 1.Teachers interpretation of the anchors varied based on their own experience and values. 2.Teachers reported that entrustment scales better allowed them to objectively report on a resident's observed behaviour as compared to traditional rating scales, however their evaluations belied that they often struggled to limit their assessments to a report of observable behaviour, choosing instead to use the form to provide summative judgments. Conclusion: Entrustment scales hold much promise, but teachers would likely benefit from faculty development including the use of a shared mental model to maximize their potential use in CBME, Background/Purpose: Pharmacists are entrusted to help patients minimize risks and maximize benefits when self-selecting treatment for minor ailments. Patients often initially access the Internet for advice. Undergraduates must understand and assimilate both patient and pharmacist perspectives on their path to self-regulated practice. Methods: Second year (pre-clinical) students (n= 240) posed as patients seeking a pharmacist's advice in a community pharmacy, after having reviewed Internet sources. Using structured guided reflection, they analyzed relevant aspects of the encounter, completed an EPA assessment of the observed pharmacist and proposed measures to personally optimize implementation of this responsibility when in practice. Perceptions were analyzed from observations, reports, surveys, class discussions and interviews. EPA rankings (anchored to 5 levels of supervision) were tabulated. Results: Student reflections, as patients, highlighted themes of entrustment and confidence in the pharmacist as an authoritative resource. As prospective pharmacists, they evaluated the clinician in terms of best practice guidelines, competencies demonstrated, barriers observed during the consultation and feelings about their future professional role. EPA reports rated the majority of pharmacists able to practice independently/unsupervised and 20% as role-models/able to supervise others. Time constraints for communication, rather than content expertise, was the primary obstacle. Conclusion: Students valued this contextual opportunity to directly experience competencies required for patient care prior to their clinical year: subject expertise, communication, collaboration, professionalism, advocacy and scholarship. Assessing practitioners' level of entrustment was considered transformative in reinforcing the importance of expertly performing this professional role with appropriate time management once in practice., Background/Purpose: Educators and researchers recently implemented developmental progress assessment (DPA) in the context of competency-based education. To reap its anticipated benefits, much still remains to be understood about its implementation. In this study, we aimed to determine the nature and extent of the current evidence on DPA, in an effort to broaden our understanding of the major goals and intended outcomes of DPA as well as how it has been executed in, or applied across, educational contexts. Methods: We conducted a scoping study informed by Arksey and O'Malley's methodology. Our search strategy yielded 2496 articles. Two team members screened them for inclusion/exclusion (90% agreement), and extracted numerical and qualitative data from 56 articles based on a pre-defined set of charting categories. The thematic analysis of the qualitative data was completed with iterative consultations and discussions until consensus was achieved for the interpretation of the results. Results: Tools used to document DPA include scales, milestones, and portfolios. Performances were observed in clinical or standardized contexts. We identified seven major themes in our qualitative thematic analysis: 1- Underlying aims of DPA, 2- Sources of information, 3- Barriers, 4- Contextual factors that can act as barriers or facilitators to the implementation of DPA, 5- Facilitators, 6- Observed outcomes, and 7- Documented validity evidences. Conclusion: Developmental progress assessment seems to fill a need in the training of future competent health professionals. However, moving forward with a widespread implementation of DPA, factors such as lack of access to user-friendly technology and time to observe performance may render its operationalisation burdensome in the context of CBME., Background/Purpose: Researchers and educators often import concepts or approaches from educational and social sciences into health professions education (HPE). One such example is “Assessment For Learning (AFL)”, which is increasing in popularity with the widespread implementation of Competency-based Medical Education (CBME). However, there seem to be several conceptualizations of this concept proposed in the literature. Our aim was to document the breadth and depth of the literature on AFL to inform its use in HPE research and practice. Methods: We conducted a scoping study informed by Arksey and O'Malley's methodology. Our search strategy yielded 5239 articles. Two team members screened the abstract and included 229 articles in the final review. We extracted numerical and qualitative data based on a pre-defined set of extraction categories. Descriptive analyses were conducted for numerical data, and thematic analysis was conducted on qualitative data. Results:20% of the articles we included for full text review had definitions that did not correspond to the use of AFL. We observed an increase in the number of articles published between 1995 and 2019. 31% of the articles were published in HPE, while the remaining articles were published in other disciplines. AFL is at the interface of many concepts (e.g., feedback, test-enhanced learning, competency-based education) which contributes to its complexity. Authors seem to confuse AFL and formative assessment. Conclusion: The complex nature of AFL may render it difficult to achieve a unified definition. In addition, the lack of uniformity in conceptualizations may hinder our understanding and implementation of AFL. Our aim is to build on these towards the operationalization and implementation of this evaluative approach in the concept of widespread implementation of CBME., Background/Purpose: Assessment strongly affects students' performance. A deeper insight needs be gained into the interplay of assessment and learning. The aim of the current study was to develop a model to explain the educational impact of assessments on students' learning, before, during and after the test. Methods: This study used semi-structured interviews (8 medical students, 7 faculty members, 1 administrative staff involved in assessment), one focus group discussion (5 medical students), and observation. An iterative purposive sampling technique was used to recruit participants according to their first-hand experience or expertise in assessment. Selection of participants to theoretical saturation continued. A qualitative paradigm using grounded theory inquiry approach of Strauss and Corbin was then used to generate an explanation of the process of how assessment system impacts students' learning. Results: The result of this study was the production of middle range theory with the core variable of “Little attention to assessment for learning”. Other related concepts include “Structural factors affecting learning,” “Strategies of learning and success in the test,” and “consequences of assessment.” Our diagrammatic model depicts the factors, mechanisms, and the outcomes of the assessment on learning within the context. Conclusion: Considering the important role of assessment in the educational process, understanding how assessment affects learning is an important issue to consider when designing a proper assessment system. The results of this study and the suggested model for educational impact of assessment on students learning can help educators design assessments for better learning., Background/Purpose: We implemented a learning activity at the UGME level that requires students to complete a structured reflection (SR) grid, while solving problems with the purpose to help them develop their diagnostic reasoning. While SR has been studied in experimental settings, no tool exists to document how students use it when implemented in a curriculum. Thus, we created and proceeded to the validation of a tool to document the quality of students' SR. Methods: Informed by the Unified Theory of Validity, we documented evidences of content (narrative description of development), internal structure (rater agreement using intra-class correlations; item analysis and internal consistency), and response processes (descriptive statistics). The analyses were done on 3 datasets (27 and 15-SR scored by 2 raters; 90-SR scored by 1 rater). Results: The tool to document the quality of SR is comprised of four indicators: 1) Diagnostic hypothesis (dx): a) relevance and b) specificity; 2) Elements supporting dx, 3) Elements against dx:, 4) Elements expected but not present in the case: a) relevance and b) elaboration. ICCs on the 27- and 15- double-scored SR were: .82 (1st indicator), .80 (2nd), .89 (3rd), and .88 (4th), and .76, .75, .78, and, .84 respectively. Cronbach's alpha was .795 for the 90 individually scored RS. Item difficulty coefficients ranged from .04 to .94, while discrimination coefficients ranged from .031 to .489. Descriptive analyses showed that students used the SR grid to compare and contrast dx. Conclusion: We created a tool to describe students' SR. Our findings suggest that the tool can be standardized and thus can provide data for research purposes or to give feedback to trainees and/or program administrators., Background/Purpose: L'évaluation programmatique encourage la rétroaction quotidienne, en particulier via l'observation directe (OD). Toutefois, aucun outil de rétroaction francophone pour l'OD (ORFOD) validé n'est disponible en médecine familiale (MF) au Canada. Cette étude visait à identifier les besoins normatifs, prescrits et perçus, pour développer et valider le contenu d'un ORFOD en MF. Methods: Une revue des ORFOD utilisés dans les programmes canadiens de MF et de la littérature abordant l'OD en éducation médicale postgraduée (Pubmed, ERIC, Educational Source et CINAHL) a identifié les formats/contenus existants, ainsi que les besoins normatifs et prescrits au sujet de l'OD. Ces résultats ont été présentés à des cliniciens enseignants et résidents de 5 programmes de MF canadiens lors de groupes de discussion, dont l'analyse thématique de contenu a mis en évidence les besoins perçus (format/contenu souhaités). Results:18 outils locaux et 31 outils publiés ont été répertoriés. Les outils publiés étaient surtout de format critérié (n=19) ou liste à cocher (n=8); seulement 6 avaient été utilisés en MF. Les besoins normatifs ont été tirés des normes d'agrément du CMFC, et les besoins prescrits, de lignes directrices sur l'OD. 18 superviseurs et 4 résidents ont participé à un des groupes de discussion sur les besoins perçus. Un ORFOD conforme aux besoins identifiés (format narratif avec guide d'observation; contenu adapté au niveau de résidence et au contexte clinique) a été conçu, puis soumis aux participants pour validation. Conclusion: Cette étude a permis de développer et de valider le contenu d'un ORFOD conforme aux besoins normatifs, prescrits et perçus dans les sites francophones d'enseignement de la MF au Canada., Background/Purpose: The clinical competency committee (CCC) comprises a group of clinical faculty tasked with assessing a medical trainee's progress from multiple data sources. Current guidelines regarding the utilization of previously undocumented data (PUD) introduced in the CCC meeting are conflicting. This study explored the use of PUD in conjunction with documented data in creating a meaningful assessment in a CCC. Methods: An instrumental case study of a CCC that uses PUD was conducted. A single CCC meeting was observed, followed by semi-structured individual interviews with all CCC members (n=7). Meeting and interview transcripts were analyzed using constructive grounded theory approaches. Results: Informal PUD were introduced as summary impressions, contextualizing factors, personal anecdotes, and rarely, hearsay. The purpose was to raise a potential issue for discussion, enhance an impression, or counter an impression. PUD supported the co-construction of a developmentally-focused trainee assessment. Various mechanisms allowed for the responsible use of PUD: embedding PUD within a structured format; sharing relevant information without commenting beyond one's limitations; clarifying allowable disclosure of personal contextual factors with the trainee pre-meeting; excluding PUD not widely agreed upon in decision-making; and providing direct in-the-moment feedback to trainees pre-meeting. Documented data were perceived as limited by inaccurate or superficial data. Conclusion: PUD appear to play a vital part of the group conversation in a CCC to create meaningful, developmentally-focused trainee assessments that cannot be achieved by documented data alone. Consideration should be given to ensuring the thoughtful incorporation of PUD as an essential part of the CCC assessment process., Background/Purpose: To promote development of caring and effective physicians, health humanities content and approaches are increasingly being introduced in medical education using different modalities, in different ways. Such integration has informed knowledge transmission, inquiry-based discovery, and other innovative processes and transformative experiences directed to democratizing medicine “for the public good” (Bleakley, 2012). Positive learning outcomes most often associated with introduction of the arts and humanities include content mastery and skills-based outcomes, such as enhanced communication, critical thinking, and ability to work on teams. Summary of the Innovation: We have developed a robust method aligning health humanities and social accountability curriculum planning to adapt knowledge relevant to practice, responding to demands from the community to meet societal needs, and helping to fulfill medicine's social accountability. This method combines curriculum mapping with a community-engaged approach to identifying curricular gaps, as well as co-developing objectives and educational modules with community partners. Conclusion: This approach to modularizing social accountability content ensures an evolving, responsive curriculum design that is sustainable, evidence-based, reviewed by multiple experts-including community partners, involves active, engaged learning, and translates to other practices. Our Graduation Questionnaire results point to transformational outcomes: improved knowledge retention, and increased student preparedness to provide care informed by diversity, health equity, and humanistic lenses. Community satisfaction with our process and outcomes has been demonstrated in public forums. Bleakley (2012). Foreword. InSight: Visualizing health humanities; www.insighthumanities.ca, Background/Purpose: According to the principles of social accountability, medical schools now have the obligation to train future health professionals to act appropriately in society and to collaborate to reform the health system so that it is relevant, high quality, efficient, equitable and sustainable for the benefit of the local communities, the country and the international community. But what particular set of competences is expected for students to develop regarding social accountability? Currently, more generic sets of competencies (e.g. CanMEDS) are not sufficiently detailed in terms of social accountability to allow programs to focus on what to do to train more socially responsible professionals. Summary of the Innovation: To answer this question, Université Laval's Faculty of Medicine organized three citizen forums, in three different regions in the province of Quebec, to co-build the competency profile of the socially responsible health professional with citizens. Using a world cafe approach, citizens identified abilities they considered “socially responsible” based on situations they had personally experienced. A qualitative content analysis was then conducted in order to categorize these elements and propose a competency profile specific to social responsibility. Conclusion: The competency profile developed to describe the socially responsible professional is composed of seven themes: 1) emotional and social intelligence 2) partnership with the patient 3) interprofessional collaboration 4) systemic thinking of health 5) systemic thinking management 6) anchoring in the community 7) ethics and social commitment., Background/Purpose: According to AAMC, strategic plans, and strategic planning, focus on articulating specific future goals or desired outcomes for medical schools and developing plans of action designed to achieve those goals. While a strategic plan is the formal documentation of a strategy, strategic planning is the specific process used to create the plan. Even if this process generally comes from the top of an organization, it must provide an opportunity to engage the community in developing the plan. However, it is not always easy to engage a variety of stakeholders in activities that go beyond simple consultation in an efficient way. Summary of the Innovation: Through its commitment to social accountability, Université Laval's Faculté de médecine developed an innovative process of strategic planning to collectively built its 2020-2025 strategic plan. The process involved more than 400 healthcare professionals and managers, faculty members, employees, students, and citizens. First, the data collected through structured participative sessions (world café and citizen forums) were qualitatively categorized using the SWOT framework. Then a second thematic qualitative analysis was inductively conducted to identify emerging themes that will become the strategic orientations. Those themes were crossed with the three strategic axis of the Université Laval institutional plan to adopt nine strategic objectives. Web consultation and additional working sessions allow to develop the operational objectives and means to be included in the action plan. Conclusion: The strategic planning followed by ULaval's Faculté de médecine is considered as an effective and socially accountable process to collectively develop a strategic plan. In addition of engaging the entire community, it quickly creates a sense of ownership in the process., Background/Purpose: Building social accountability (SA) into research is an important priority and expectation of medical schools. It is therefore necessary to evaluate to what extent research conducted within medical schools includes elements of SA. We aimed to create a tool to determine the degree of SA in medical student summer research project (MSSRP) proposals as a whole. Summary of the Innovation: We developed a draft tool based on a search of the literature, meetings with faculty and staff, other similar resources and from analysis of MSSRPs themselves. Four independent reviewers used the tool on six randomly selected proposals to ascertain consistency and reproducibility of results. We then modified the tool and one author (DN) used it to evaluate 187 MSSRP proposals from 2018 and 2019. The final tool focused on evaluating equity, and community engagement in research proposals. We found low levels of social accountability. In 2018 and 2019, we found no evidence of any SA in 57.8% of proposals. The average equity score was 16.5%, the average community engagement score was 8.8%, and the total SA average over 187 proposals was 14.0%. Conclusion: We created a tool that we used to evaluate the level of SA in MSSRP proposals and which other institutions can use to evaluate their own research. The process of developing this tool helped refine and operationalize a working definition of social accountability., Background/Purpose: The World Health Organization has called for more socially accountable models of medical education. To date, service learning, student-led clinics, and explicit medical school mandates have been shown to facilitate the teaching and learning of social accountability in medical schools. Given that social accountability is a guiding principle within many medical schools, there is a need for more research to help bring to light pedagogical processes for developing social accountability and how such processes are experienced by learners. Thus, the purpose of this study was to explore undergraduate medical students' experiences and perspectives on social accountability. Methods: Using a retrospective exploratory qualitative design, thirteen one-on-one semi-structured interviews were completed with undergraduate students in Year one through four. Each interview was recorded, transcribed verbatim, and analyzed by two researchers independently. Results: Students described two types of praxis needed to develop a social accountability framework through medical school: (a) relationality praxis developed through interaction with mentors who use social accountability in their own practice and by listening to and understanding different voices and perspectives on social accountability; and (b) professional place praxis which recognizes the place bound and place dependency of social accountability and its specificity to a community. Conclusion: Social accountability is now a central feature of medical schools in Canada. This study highlights how important relationality and place are foundational to the teaching and learning of social accountability. Lastly, engaging student perspectives is imperative for understanding how social accountability is transforming medical education., Background/Purpose: Most Canadian medical schools apply admissions policies to allocate seats according to the applicant's province or territory of residence. The preferential selection of regional students may mean that access to medical school is inequitable, and higher performing students from particular provinces are disadvantaged. Methods: Through review of publicly available data from multiple sources, this descriptive policy analysis determined the number of medical school seats that are potentially available to applicants from each province and territory. The comparative availability of medical school seats for applicants from each province or territory was then established as a function of the total number of available seats in Canada, regional application pressure, and estimates of the total possible regional application pressure. Results: The results show that applicants from Quebec were afforded the greatest number of potential seats (1761), while those from Saskatchewan are afforded the fewest (1006). When considered with respect to application pressure, the greatest number of seats per applicant were realized for applicants from NWT/NVT (90.4) and PEI (26.4). Ontario applicants had access to the lowest number of seats per applicant (0.23). Conclusion: The results are discussed with respect to the challenges associated with balancing values of equity with principles of regional social accountability. Privileging regional residence over performance may be justified by strong evidence that these applicants are ultimately more likely to serve patient populations which would otherwise not be served, coupled with evidence that small variations on admissions assessment tests do not impact the quality of physicians in practice., Background/Purpose: Empathic care of patients is well-accepted, but the same empathy is often lacking among health care providers towards each other. This interactive workshop provides an opportunity for health care providers to reflect upon, “Why do we treat each other poorly?” and “Why does it matter?” Participants will acquire leadership skills to promote interprofessional empathy. Summary of the Innovation: We developed this 10-minute video, The Threads Among Us video, which depicts a patient undergoing a GI procedure while incivility is demonstrated among the medical team. The video forms the basis for a conversation about common incivility experienced by learners, trainees and faculty. There is particular emphasis on interdisciplinary relationships in a clinic a setting. This discussion uses 3 major concepts: The idea of social contagion and behaviors, The ladder of inference, a framework of emotional intelligence, and the importance of gratitude. We view this video and discussion as an excellent teaching tool. Conclusion: We have piloted the Threads Among Us workshop to diverse groups of learners and physicians, including nurses, medical students, residents, and attending physicians. Evaluations show 52% reported they observed incivility several times a month in their own department; 60% in other departments; and 27% reported incivility was directed toward themselves. 94%-97% indicated the workshop video was excellent, 97% would recommend the video and the workshop to others., Background/Purpose: We developed a novel tabletop simulation approach to identify workplace practices and intrapartum care providers' underlying rationales for how they work through challenging interprofessional clinical scenarios. These simulations also contributed data to an institutional ethnography exploring the ruling relations influencing workplace practices on the labour and delivery (L&D) unit. Summary of the Innovation: We combined 'think-aloud' and simulation principles to design an approach for eliciting healthcare professionals' descriptions of how they collaborate in their work on a L&D unit, and their rationalizations for why they work that way. We engaged an interprofessional team of intrapartum clinicians, researchers, and simulation experts to design three tabletop simulation scenarios reflecting key challenges identified from analyzing incident analysis reports (n=81), field observations (72 hours), and semi-structured interviews (n=15). We ran each scenario three times with three separate teams of interprofessional clinicians from the unit. Conclusion: The tabletop simulations revealed 'disjunctures' in how different professionals interpreted and adhered to key policies and procedures. These scenarios allowed us to examine longitudinal work processes in a condensed timeline, with opportunities to pause and probe, and with reduced focus on individual practitioner's competence. Moreover, participants described how the scenarios opened a productive dialogue between professional groups and suggested this simulation-based approach might contribute to enhanced interprofessional understanding and cultural change. Our innovative tabletop simulations produced rich data about what drives professionals' actions in veritable clinical cases, improved their engagement in change processes, and laid the foundation for informed change of policies and practices on the unit., Background/Purpose: Inter-professional collaboration (IPC) can be fraught with multiple tensions. In part, due to implicit biases within teams, which can reflect larger social, physical, organizational and historical contexts. Such biases exist outside conscious awareness, yet may influence IPC in both explicit and implicit ways. They may also influence communication, trust, and how collaboration is enacted within larger contexts. Overall, their influence on IPC is relatively under-explored. Therefore, the authors conducted a scoping review on the influence of implicit biases within inter-professional teams. Methods: Using a scoping review methodology, the authors searched several online databases. From 2792 articles, two reviewers independently conducted title/abstract screening, and assessed articles for full-text eligibility. Reviewers then extracted, coded, and iteratively analyzed key data from 159 articles using a framework derived from socio-material theories. Results: Overall, there was a paucity of research that described non-human influences, often focusing on single material elements instead of dynamic aspects of collaboration. In addition, the relationship between racial, age-related, and gender biases with IPC appeared largely unexplored in the literature. Many studies demonstrated how implicit biases regarding dominance and expertise were internalized by team members, influencing collaboration in mostly negative ways. Articles also described how team members adapted to such biases. Conclusion: Our findings suggest that implicit biases remain relatively under-explored within IPC and sociomateriality may provide a useful framework to explore how bias influences different types of inter-professional initiatives. Future research should consider the longitudinal and reciprocal nature of both positive and negative influences of bias on collaboration in diverse settings., Background/Purpose: Healthcare providers (HCP) must master technical and non-technical skills (NTS) necessary to ensure patient safety and favourable outcomes. In situ simulation (ISS) possibly improves teamwork and team satisfaction, however evidence describing the effect of ISS on HCP NTS is not well described. We aimed to conduct a needs assessment to identify knowledge and competency gaps regarding NTS of HCP during acute events. Methods: HCP in a level 3 NICU completed a questionnaire: 1) Open-ended comments on key concepts; 2) Needs assessment based on their past experiences in acute events; 3) Perceptions of past team performance and latent safety threats (LST) during critical events; 4) Perception of quality of interactions with other professionals during emergency interventions, open-ended questions about expectations in terms of training and barriers to participating in simulation training; 5) Demographics. Results:125 HCP responded (40% response). Crisis resource management and specific NTS (communication with families during events, teamwork and controlling stress) were identified as training needs. At least 50% of respondents state that during critical events 1) they feel anxious, 2) have the impression that a leader is never identified, 3) leaders do not coordinate communication between team members, 4) team members do not repeat or feedback information to ensure comprehension in the team. Two thirds of respondents identify lack of transfer of information as the main LST during acute events. Conclusion: Competency gaps of HCP are related to NTS and specifically leadership, communication and stress management, which are essential to ensure patient safety and favorable outcomes. Upcoming ISS curriculum will include these concepts and will measure its effect on HCP behaviors and institution culture change., Background/Purpose: Learning in complex clinical environments requires health professionals to assess their performance, manage learning, and modify practices based on self-monitored progress. As self-regulated learning (SRL) theory suggests, however, learners often need guidance to enact these processes effectively. Simulation debriefings may an ideal place to prepare learners for self-regulated learning in targeted areas, but at present may not be optimally fostering these practices. This study aims to explore the nature of learning after team-based simulation. Methods: A qualitative grounded-theory study was conducted in the context of an interprofessional in-situ trauma simulation program. Participants were interviewed both immediately, and 4-6 weeks after the simulation experience. Transcripts were analyzed in an iterative constant-comparative approach to explore emergent themes and concepts surrounding our research question Results: There were numerous examples of acquired content knowledge and plans for straightforward practice change during initial interviews; however, more sophisticated examples of SRL were lacking early on. Some participants appeared to have evolved more specific goals and rudimentary implementation plans by the follow up interviews, but many suggested this was prompted by study interviews rather than the simulation debriefing itself. Conclusion: While participants did not develop fulsome SRL plans after the simulation, there were elements of SRL seen once learners had time to reflect on the questions and their own goals. This is an encouraging sign that simulation can support development of SRL skills, however, debriefing approaches would need to be optimized to take full advantage of the opportunity to encourage and foster these skills in practice after the simulation is over., Background/Purpose: System-wide change is essential to transform health care for patients with co-morbid physical and mental health illnesses. Clinicians lack necessary training to optimize team-based management of these complex conditions. The Medical Psychiatry Collaborative Care Certificate (MP3C) program is a continuing professional development initiative designed to fill this gap, with 4 foundational and 8 practice improvement modules. Methods: To evaluate interest in MP3C across different health care settings, MP3C modules were offered in a large suburban community hospital, an academic mental health facility, to an established interdisciplinary pediatric team, and through a regional primary care rounds series. Participants provided feedback via module evaluation, with questions about valuable use of time, referral of colleagues, and interest in attending future sessions. Results: Attendees were as follows: Community Hospital: 305 total; Mental Health Facility: 30 total; Established Interdisciplinary team: 6 total; Primary care Rounds Series: 74 physicians. A majority of participants reported that MP3C was a valuable use of their time (93 -100%), would recommend the program to a colleague (89-100%) and plan to attend additional modules (79% -94%). Conclusion: The education approach worked across different sectors with the highest level of engagement to date in the community hospital setting. It was well received in various settings but different approaches were required to meet the needs of primary care, including specific primary care rounds. Ongoing evaluation of participant feedback has demonstrated feasibility and relevance to clinical practice of the MP3C program across a range of interdisciplinary health care participants and educational platforms., Background/Purpose: Given the complexity of patient care, integrated physical and mental health training starting in undergraduate medical education is needed. Moreover, curricula are needed that foster adaptive expertise early in medical student training. Informed by adaptive expertise, we developed a low-fidelity simulation for 2nd year medical students based on a previously established Deteriorating Patient Simulation (DPS) model. We delivered our integrated care DPS to all 262 students and explored students' learning within this education program. Summary of the Innovation: The DPS involved a case of a patient living with mental illness who develops physical and mental health symptoms in a community and acute care settings. Paired student observers in groups of nine worked collectively to manage 10 scenario deteriorations facilitated by a workshop leader oriented to the DPS model. We explored learning by asking students two open-ended questions post-DPS assessing: (1) their learning of health-system challenges, and (2) their perspectives on the limitations of standardization of care. We used anonymized aggregate student responses for qualitative thematic content analyses. Conclusion: Students reported that DPS increased their understanding of patient care challenges in three areas. First, students recognized how challenges with integrated care can result in patient loss of autonomy. Second, issues related to healthcare professionals' stigma and bias towards mental illness were identified. Third, challenges in the healthcare system related to care coordination and navigation. Students saw the utility of standardized care pathways and care guidelines. Our preliminary DPS data suggests it provides students with opportunities to learn about multi-level challenges with integrated healthcare. This data will be used to further develop the DPS model for integrated care and to further explore students' learning and outcomes., Background/Purpose: Associated with the increasing interest in student global health placements is the recognition that these placements impose unique ethical demands for involved stakeholders (Pinto & Upshur, 2009). These ethical demands are situations that can be anticipated using simulation cases (e.g. Mills et al., 2014). Pre-departure training is the opportune time to engage students with these ethical demands through simulations with role-playing peers to bring a sense of realism to probable observership scenarios that often occur. Methods: This mixed methods research investigates the perspectives of participants in active role-playing simulations that occurred during a pre-departure training curriculum. Two cohorts totaling 112 participants completed a mixed-survey immediately afterwards. Results: The participant reaction to the simulated cases was overwhelmingly positive (86% approval) and with 77% of participants reporting the scenarios increased their preparedness to confront ethical issues on their observership. Participants reported that the simulations allowed them to experience and confront uncomfortable, but realistic situations safely with peers and mentors supporting them with immediate feedback. Participants also credited the role-playing with fostering greater sense of teamwork and facilitating an impromptu post reflection where they would have to reconsider their efforts for sustainable advocacy Conclusion: Participants were immensely positive and despite some initial discomfort with acting in front of their peers they participated enthusiastically. We aim to show that case study role play simulation is an effective way to give students exposure to the kinds of ethical dilemmas that they might encounter in their global health observerships and beyond., Background/Purpose: Cadaver Based Simulation (CBS) is on the rise in Canada, due to recent advances in cadaveric preservation. However, the CBS literature tends to focus on perceptions of CBS and procedural performance. The complex work involved in CBS, particularly the invisible work of clinical cadaver staff, is little understood. This presentation therefore examines how cadavers, learners, workers, tools and spaces come together in a clinical cadaver program and offers implications for wider processes and discourses of simulation learning. Methods: Our ethnographic methods (observation [n=30 hours], interview [n=30], document analysis [n=22]) allowed us to follow the cadaver before educational use (cadaver preparation), during (learning sessions with physicians, residents), and after (memorial service) over a two-year period (2018-2020) at Dalhousie University. Results: Our analysis identified a complex work and educational “life cycle” of the cadaver, from its entrance into the body donation program through to burial and interment. This cycle is characterized by a series of transitions as cadavers pass through the hands of multiple actors. Some of these shifts were obvious (e.g., passing the threshold between home/hospital and morgue) and others were subtle, rapid, and constantly changing (e.g., moving between person and tool). Conclusion: Cadavers require a complex system of invisible work processes within and beyond the classroom. CBS requires workers and learners to navigate the tension between treating the body as an anonymous educational tool and as a specific, whole person. Better understanding this nuanced process may inform how we use cadavers in medical education., Continuous development of professional skills relies in part on the mobilization of cognitive, organizational and pedagogical resources. The “tacit” or experiential knowledge that professionals acquire in their work is one such resource (Polanyi, 1966; Henry, 2010), which is not found in textbooks or Google although it's part of their “cognitive toolkit”. It has the advantage of building on experiences unique to each context. Aim: By identifying and mobilizing these “tools” this research aims to understand how tacit knowledge is mobilized, shared with others (colleagues, students), and more interestingly, how it generates new knowledge, which is reinvested in continuous professional development. We filmed and selected work sequences taken during an emergency simulation at a Montreal trauma hospital, showing nurses and MDs working collaboratively. We invited them to participate in an “activity clinic” (Clot et al. 2000) an approach to work analysis in which professionals see themselves working and discuss their thought processes during the sequence. The interviews are conducted first individually, then in pairs and are recorded. The method enabled us to “dislodge” themes revealing cognitive processes engaged by individual professionals during the simulation. By sharing personal cognitive processes within the group, by referring to specific filmed sequences, a deeper mutual understanding was generated which led to identifying specific improvement initiatives. Conclusion: We claim that this participatory research allows professionals to re-discover their work by discussing with colleagues, a process that generates new avenues for learning that can be reinvested in their practice., Background/Purpose: Medical educators increasingly prioritize Patient Centred Care (PCC), and have identified simulation as a promising area for pre-clinical PCC practice. However, due to the traditional separation of “hard” and “soft” skills in medical curricula, patient centredness is often associated with simulated patients and overlooked in clinical skill sessions with manikins. Manikins are often assumed to be “human enough” for skill practice but their influence on teaching and learning PCC can be overlooked. We therefore sought to understand (1) how manikins shape teaching and learning in undergraduate medical simulation, and (2) implications for PCC. Methods: Informed by a broader body of data, this presentation offers a sociomaterial analysis of a third-year pre-clerkship simulation that combined six clinical skills within one overarching case. Two sets of student and instructor pairs were each assigned to a male-presenting medium fidelity manikin overlaid with an IV arm, phlebotomy trainer, and injection pad. Our ethnographic methods included video observations (n=240 minutes), curriculum analysis (n=8), and interviews (n=11). Results: Human-manikin interactions both affirmed and undermined PCC. Affirming actions included teachers voicing patient concerns and directing students to seek consent; and students offering the patient procedural choices. Undermining elements included lack of student-patient communication; leaning on the manikin; centring teacher approval and expertise; and caricaturing the patient as stereotypically feminine. Conclusion: Patient centredness is both affirmed and undermined in manikin-based simulation. The material form of the manikin complicates PC teaching and learning. Intentionally planning for this complexity may ensure more consistent adherence to patient centred principles., Background/Purpose: Learners in Psychiatry and Community Rehabilitation and Disability Studies (CRDS) work in high stress situations with patients and clients in distress during their residency and practicums. This presentation provides an overview of the evaluation of an innovative cross-disciplinary project between Psychiatry and CRDS using simulations of patients and clients in distress. Methods: Both qualitative and quantitative data was collected and analyzed using learner surveys and focus groups to assess their perspectives of the efficacy of this educational intervention in their professional development. Using a Realist Analysis (Pawson, 1997, 2006, 2013) the team employed a combination of generic theme analysis and template analysis in combination with a context-mechanism-outcome (CMO) triad to build theories and interpretations of the role of simulations in this learning context. Results: The data demonstrates learner's positive responses to the use of simulations in their increased confidence and learning and ability to engage more safely with uncomfortable emotions around working in complex situations. Conversely, we found that a lack of clarity around roles and goals increased feelings of uncertainty and distress amongst learners Conclusion: Drawing from each disciplinary context, training level and data collection method, this presentation highlights the ways in which we have been able to engage learner perspectives to further develop simulations which address the very real, and competing priorities of the physical and emotional safety of both professionals and patients/clients which was expressed by our learners., Background/Purpose: Expanding medical knowledge coupled with new requirements to foster multiple competencies has created pressure for medical school curricular time. Noting a recent decline in second year student classroom attendance, we conducted a survey to better understand student behaviour. Many students identified experiencing difficulty fulfilling all curricular and non-curricular obligations and reported high stress levels based on multiple competing demands. Summary of the Innovation: In response, we created the “flextime” curricular pilot. Flextime reorganizes the way content is delivered, maximizing unstructured curricular time, clustering independent learning opportunities and allowing students greater autonomy over their schedule. Prior to the pilot, the second year student schedule was structured 80% of the time with little predictability. While some of the scheduled time was identified as independent learning, these time slots were interspersed with classroom sessions requiring in-person attendance. The flextime schedule provided students with 40% of the week block booked as unstructured time, with a set of independent learning tasks to be accomplished in a self-scheduled fashion. Students were re-surveyed following the innovation. Conclusion: The described curricular reorganization was positively received by students, with no change in student performance. Allowing students flexibility in learning events was shown to increase the perceived importance of in class sessions, without impacting grades., Background/Purpose: Graduating medical students have a high prevalence of distress before residency training regardless of specialty choice. Medical school provides the opportunity to prevent and manage mental health and psychological distress in a high-risk population early in medical training. Research has shown that students and trainees prefer to seek support from peers rather than approaching health professionals or faculty members for help. Student-led peer support programs in medical school could be a valuable addition to existing faculty programs and services by promoting help-seeking behaviors and fostering resiliency. Summary of the Innovation: The goals of the peer support program are to improve help seeking behaviours, reduce stigma and provide non-judgemental, accessible and confidential peer support from students who have undergone professional training. The recognition of behavioural changes will allow peer supporters to: 1) identify students who are at risk of experiencing distress, depression or suicidal ideation, 2) provide peer counselling and 3) facilitate their pathway to proper resources and professional services. The development and implementation of the program Side by Side started with the recognition of students' needs before filling an existing gap and complementing pre-existing services. Extensive research led to the idea of building a cost-effective peer support program benefiting from the proximity of medical students and their expertise in understanding medical school challenges. Recruitment of a working group composed of students from all years and faculty has allowed to target the specific needs of the student population. A survey assessed barriers to seeking help and gathered student preferences regarding the program. Selected peer supporters from all years of medical school completed a thorough training program tailored for the prevention and management of mental health crises. All peer supporters offer weekly hours of availability for students and must attend monthly debriefing sessions with a faculty counsellor to ensure their own wellbeing and quality of interventions. Conclusion: A comprehensive and collaborative approach is needed to improve mental health among students early in medical training. In our survey, 85% of students indicated that they would feel relieved or indifferent if a peer supporter reached out to them based on behavioural changes. Thus, peer support programs should adopt an integrative, proactive, and preventative approach. Peer support is a step towards a culture that values physician wellness and away from one of invulnerability and shame. Careful evaluation will ensure the quality of a program that fits the needs of medical students., Background/Purpose: Indigenous people in Canada face discrimination and racism in healthcare. The Role of Practitioners in Indigenous Wellness is an online course delivered by Indigenous community members, through stories of intergenerational trauma, racism and colonialism, and the effect on health care experiences of Indigenous people in Saskatchewan. Cultural safety and communication strategies are emphasized. Summary of the Innovation: Forty-nine residents completed the 24-hour course from September 2018-July 2019. Interactive components were facilitated by an Indigenous content expert who encouraged self-reflection and an active voice in blogs. Kirkpatrick's Model was utilized to evaluate learning: 1) Reaction: post-course satisfaction survey; 2) Learning: pre and post-course vignette responses; 3) Behaviour: communication strategies evaluated by iterative thematic analysis; 4) Transformational Goal Setting: creation of a cultural safety practice goal at course completion. High levels of satisfaction were reported, and residents indicated their knowledge had improved following the course. Initial analysis of communication strategies identified the following themes: 1) importance of ongoing development, 2) self-reflection in practice, 3) need for open communication about racism and bias, 3) culturally safe and welcoming communication, 4) patient engagement, patient-centered care and relationship development, 5) respect and integrity, 6) advocacy for resources, 7) culturally informed care, and 8) traditional care options. Conclusion: Communication strategies discussed self-reflection, open communication about racism, building relationships, provision of welcoming space and traditional options for patients to ensure culturally responsive care. Course organizers have determined that participants may require more direct support for transformational goal setting so long-term impacts can be evaluated., Background/Purpose: We are in a critical period within the medical profession as physician burnout rates reach a peak. We conducted a systematic review to estimate the global prevalence of burnout in residents. Secondly, we investigate how it has evolved in the past few decades and identify associated factors. Methods: We searched 6 databases from inception yielding 8,505 studies, of which 197 met our eligibility criteria. They comprised data from over 44,000 residents across 47 countries. We used meta-analysis to calculate pooled prevalence, and meta-regression to study associated factors. Results: The pooled global prevalence of burnout was 47% (95% CI 43.1%; 51.5%). Our meta-regression suggested that the region of residency was significantly associated with burnout, with North American residents affected at higher rates. Additionally, we found that burnout rates have not significantly changed over the past 20 years. Lastly, we report that burnout was not associated with the specialty or level of training, age, sex, relationship status, or work hours. Conclusion: Strategies to mitigate burnout through duty hour restrictions have been largely inconsequential since burnout rates appear unchanged over two decades. Our findings suggest that traditional risk factors (e.g., age, sex) do not in fact impact rates of burnout. Rather, it appears that systems, such as regional differences in the medical culture, play a large role. This is the unsettling state of burnout among the resident population; an important discussion at the forefront of medical education, in which the answers seem further than ever before., Background/Purpose: Cognitive flow describes a state of enhanced focus, awareness, performance, and satisfaction with one's work or practice. Fields outside of medicine including elite sport have long incorporated psychological skills training to help performers enter flow states, but this phenomenon has yet to be explored deeply in medicine. The present study sought to determine if the phenomenon of flow is relevant to surgical practice and if so, how it is experienced by surgeons. Methods: Using a constructivist grounded theory methodology, semi-structured interviews were conducted with 18 staff surgeons at the University of Toronto, purposively sampled for experience levels and practices. Data were coded and analyzed iteratively by three researchers until theoretical saturation was achieved. Results: Although many surgeons were unfamiliar with cognitive flow, the phenomenon resonated with most. Participants identified conditions that supported flow states and allowed surgeons to positively engage in their work. Although flow has traditionally been considered a cognitive phenomenon, surgeons described the experience as multidimensional, shaped by physiological, emotional, sociocultural, and environmental facets. For example, surgeons identified a shared state of social flow: “Sometimes you achieve flow with a trainee that you're guiding through a case, which is kind of fun as well. So you experience flow through another person.” (P4) Conclusion: Understanding flow and other positive states in clinical practice may help enhance career satisfaction, combat burnout, and promote physician wellness., Background/Purpose: The practice of medicine is expected to be psychologically challenging at times. During episodes of significant emotional distress, physicians desire peer support. However, the features of informal, effective peer-based emotional support, how it arises, and its contribution to practitioner well being have not been well described in the medical literature. Methods: A purposeful sample of Canadian rural physicians with a rich and meaningful experience of informal peer support for work related stresses were interviewed. Semi-structured interview questions focused on the experience of the support, the conditions under which the support arose, and the perceived value of the support. Interviews were coded and the data interpreted from a hermeneutic phenomenology perspective. Results: Through peer support, participants experienced a substantial reduction in emotional distress, and were more able to process and move through difficult experiences. The majority of participants felt that the peer support was crucial to their willingness to continue to practice medicine. Useful qualities of the support included listening, a nonjudgmental attitude, normalizing, reframing and validation. Peer support most commonly arose as result of an invitation from the peer, in the form of the peer asking: 'how are you?'. Even very brief, one-time interactions were meaningful. Conclusion: Informal peer support can be a significant factor in physician retention in medicine, as well as in supporting practitioner wellness. Promoting and supporting informal peer support at a system level, through medical leadership and medical education, may be a low cost intervention with rich rewards for practitioners and the health care system., Background/Purpose: Residents in the psychiatry program at McMaster University indicated a desire for a practical, skills-based transition to practice curriculum. With the transition to competency-based medical education and its focus on having a robust transition to practice year, our program was invested creating a novel, pedagogically robust curriculum. Summary of the Innovation: A needs assessment was sent out to the PGY-5 residents during the 2018-2019 academic year. The results from this survey informed the development of a 3-session curriculum focusing on: 1) negotiating, contracts and business incorporation, 2) billing and practice management, and 3) transition to practice “nightmares” like audits and college complaints. A curriculum based on cases was developed to reflect these learning needs. External and internal experts, including legal counsel, medical business and billing experts, and experienced faculty were included as teachers. The curriculum included didactic and interactive components anchored to cases and concluding with practical, concept-integration application exercises to enhance knowledge retention and application. Conclusion: Feedback was sought through session evaluations and a survey following completion of the curriculum. Residents felt the curriculum was helpful and applicable, although noted a preference for earlier delivery. Additional topics of interest were identified. Using a quality improvement approach, the curriculum has now been expanded to 8 sessions including additional application exercises focused on billing, maintenance of certification, and ethical issues. This presentation will provide attendees with an understanding of how to create a practical transition to practice curriculum and will provide examples of the curriculum, including integration exercises used to solidify learning., Background/Purpose: CBD is a hybrid competency-based model that focuses on residents' abilities in relation to the competencies needed for success in practice. This model is based on five components: framework of competencies, sequenced progression, tailored experiences, competency-focused instruction, and programmatic assessment. There has been a limited exploration of residents' experiences of implementation of CBD thus far. We explored residents' mental models in relation to the core components and their general experiences to identify if CBD implementation in the first 8 disciplines is occurring as it was conceptualized. Methods: A descriptive qualitative design was used to explore and better understand the resident experiences. All residents who had exposure to CBD implementation were invited to participate. We conducted face-to-face or telephone semi-structured interviews. Interviews were digitally recorded and transcribed verbatim. Thematic analysis was used to create data-driven codes and identify themes and subthemes. We used an iterative consensus building process to reach saturation. Research Ethics Board approval was obtained. Results: A total of 20/50 (40%) residents representing 6 different disciplines from the 1st(n=4) and 2nd(n=16) cohorts of CBD implementation were interviewed. Five main themes emerged: i) value of feedback; ii) strategies for successful Entrustable Professional Activity(EPA) completion; iii) challenges encountered in CBD; iv) general perceptions regarding CBD, and v) recommendations to improve on existing challenges. Conclusion: Exploring residents' mental models of CBD core components and understanding their experiences on the implementation will help identify/disseminate successes, challenges and future directions from the residents' perspective to assist programs at different stages of CBD implementation., Background/Purpose: As Competence by Design is being implemented across Canadian residency programs, little is known about residents' perspectives on this method of training, despite them being most directly affected by the transition. This study examined the perspectives Canadian residents have regarding the advantages and disadvantages of competency-based medical education (CBME) and its implementation. Methods: This mixed method study consisted of a single phase where an online questionnaire consisting of both Likert-type items (6-point scale) and open-ended questions was administered to residents enrolled in post-graduate programs across Canada. 434 residents completed the survey. 139 respondents were in CBME programs and 295 respondents were in pre-CBME programs at the time they completed the survey. An emergent thematic approach was used to analyze the qualitative survey data. Results: Three themes emerged: program outcome concerns, changes, and emotional responses. In relation to program concerns, residents pre-CBME and those in CBME were concerned about administrative burden, challenges with the assessment process, and quality of feedback. Residents pre-CBME were concerned about faculty engagement and buy-in. In terms of changes, both groups of residents discussed a more formalized assessment process. Residents pre-CBME and those in CBME reported strong emotional responses such as experiencing more stress and frustration. Residents in CBME reported being more proactive in their learning and engaging in more self-reflection. Conclusion: Our findings demonstrate that residents across Canada have mixed feelings and experiences regarding CBME. The reported concerns suggest that programs will need to address specific shortcomings to increase buy-in, and that cultural shifts may be required., Background/Purpose: At Université de Montréal, progress tests (PT) are formative assessments which are administered on the final 2 years of the curriculum. We sought to assess the value of these tests for predicting success to the Medical Council of Canada Qualifying Examination part I (MCCQE I). Methods: Five compulsory, formative PTs have to be taken by students during clerkship, the first 3 in year 3, and the last 2 during year 4. From 2013 to 2018, student scores from PTs and MCCQE I were prospectively gathered, and Pearson's coefficient was used to look for a relationship between the two. PT scores were also divided into deciles and analysed for risks of failing the MCCQE I. Results: Results of 1496 students were analysed. A strong correlation was shown between PT scores and MCCQE I scores (r=0.635, n=1496, p 0.500). Students with mean PT scores in the lower decile were 6 times more likely to fail the MCCQE I (RR=6.4673, 95% CI 3.7727-11.0872, Z=6.788, p, Background/Purpose: The Computer-based Assessment for Sampling Personal characteristics (CASPer) is a situational judgement test (SJT) that is adopted by medical schools to assess for interpersonal and professional characteristics of applicants. Unlike conventional SJTs whereby test takers select their preferred response to an ethical dilemma from a series of choices, applicants writing the CASPer compose their own responses, thereby providing a window into the applicant's rationale for ethical decision-making. Underrepresented minority medical school applicants usually lack access to a network of individuals and/or resources that offer guidance and prepare them for the various application requirements of medical school. Summary of the Innovation: Under the support of University of Toronto's Community of Support program, medical students at the University of Ottawa designed and taught a free online CASPer coaching program for underrepresented medical school applicants across Canada. The program consisted of 35 learners and three medical student tutors. Important attributes of the 4-week program included free access to a medical ethics book, insight sharing from three distinct tutors, feedback provision to in-class and homework responses, and facilitation of a mock CASPer test. Through extensive peer-to-peer mentorship, we aimed to reduce anxiety, improve confidence, and increase competency among minority students in our CASPer coaching program. Conclusion: Results from our pre and post-program survey showed significant student improvement in familiarity with the test, increased competence, confidence and preparedness, as well as reduced anxiety (p, Background/Purpose: Both the CFPC and the Royal College have implementing a 'Residents as Teachers' initiative into their curriculum. Opportunities to teach undergraduate students are encouraged. Searching for the correct opportunities that benefit both the medical student and the resident trainee are challenging. Summary of the Innovation: We created a sustainable and structured postgraduate rotation that provides robust teaching opportunities for the resident trainees while providing trainees with approachable content experts to teach them clinical skills, communication skills and ultrasound sessions. Residents from three different postgraduate programs participated and a total of 16 residents took part. Residents also participated in a scholarly project of their choosing including a reconstruction of a teaching session (often implementing clinical reasoning and elements of evidence-based physical examination), a quantitative medical education project or a quality improvement project. They received faculty development training in teaching on the fly, the learner in difficulty, giving and receiving feedback. Residents also benefited from a peer-review session. This is the first rotation of its kind in Canada. Conclusion: The Medical Education Elective rotation at UBC has grown and been a very successful addition to the Undergraduate program. Residents feel inspired and have come away with improvements in their teaching skills as well as their analytical thinking and ways to deliver content. It has also managed to strengthen the connection between UGME and PGME at UBC with a large burst of prior Medical Education Elective Residents returning to teach /become faculty members upon their residency graduation thereby increasing the overall number of teaching faculty., Background/Purpose: The research-based four-phase R2C2 feedback and coaching model draws on collated performance data to build Relationship, explore Reactions, determine Content and Coach for change to co-create an action plan. While successfully used for progress meetings, it had not been studied in clinical settings in which brief feedback conversations occur after learner experiences. The purposes of this study were to explore how supervisors adapted the model for in-the-moment feedback and coaching, and develop a guide for its use in this context. Methods: We interviewed 11 purposefully selected clinical supervisors to explore when they used the model, how they adapted it for in-the-moment conversations, and phrases they used in each phase that could guide design of an R2C2-in-the-moment model. We used framework analysis to synthesize interview data and conducted two research team consensus meetings to confirm findings. Results: Participants readily adapted the model to varied feedback situations across several disciplines and clinical environments. They identified phase-specific phrases that could enable effective coaching conversations in a limited amount of time. Results facilitated revision of the original R2C2 model for in-the-moment feedback and coaching conversations, design of an accompanying trifold brochure, and website information (https://medicine.dal.ca/departments/core-units/cpd/faculty-development/R2C2.html) to support its use. Conclusion: The R2C2-in-the-moment model offers an approach to feedback and coaching that builds on the original model while addressing time constraints and the need for an iterative conversation between the reaction and content phases, while enabling the supervisor to coach and work with the learner to co-create an action plan to improve performance., Background/Purpose: Coaching has been investigated as a method of facilitating the development of medical trainee expertise over the past decade. However, few studies have considered how advances in coaching science within other domains could be applied to medical education. In the present study, we perform a state-of-the art review of recent coaching literature from several domains. Methods: Five databases and Google Scholar were reviewed between 2016 and 2019. Search terms included: coach, skill, performance improvement, goal setting. Articles were excluded if they focused on business, wellness, youth, or family coaching. Study design, setting, coaching framework, and limitations were extracted. Results: Seventy-eight articles were included which spanned medical professionals (55%), schoolteachers (21%), and athletes (15%). Thirty-four percent of studies involving medical professionals demonstrated significant improvement in technical skill performance following a coaching intervention. Studies involving teachers were frequently underpowered or showed non-significant interactions. Studies with athletes demonstrated that coaching interventions which resulted in improved performance tended to focus on mental imagery, preparation for dealing with high-stress scenarios, and periodized approaches to skill development. Conclusion: There is currently heightened interest in applying coaching techniques to medical training yet only a third of studies reported its effectiveness for improving performance. The sport coaching literature offers several promising techniques that could be highly effective in preparing medical trainees for independent practice., Background/Purpose: The primary purpose was to conduct an evaluation of The College of Family Physicians of Canada's (CFPC) Fundamental Teaching Activities (FTA) Framework, a guide for Faculty Development. Methods: Using a practical participatory evaluation approach a partnership between the project team and members of the CFPC Faculty Development Education Committee (FDEC) solidified the evaluation design, development of data tools, implementation strategies, validated key findings, and dissemination. Faculty Development programs across Canada were targeted for this evaluation, particularly Faculty Development Directors, Postgraduate Directors, and Site Directors were invited to participate. Mixed methods consisting of an online survey sent by FDEC to all Family Medicine Faculty Development Directors, Postgraduate Directors, and Site Directors and follow-up interviews with self-selected participants conducted by the research team. Results: The surveys were distributed to the 15 Faculty Development Directors, the 18 Family Medicine Program Directors and 174 Family Medicine Site Directors in the Fall of 2018, soliciting response rates of 80%, 66.7%, and 19.5% respectively. Interviews were conducted with a representative sample of 12 survey participants in the Winter and Spring of 2019. Surveys and interviews were conducted in either French or English. Survey and interview responses suggest that awareness of the FTA was highest among Faculty Development Directors. There have been varied levels of implementation of the FTA framework across the country. Conclusion: Program Directors reported utility for programmatic planning. Recommendations to reduce barriers to implementation, such as readability and clarity of the FTA and highlighting the collective and individual values of the framework will be presented., Background/Purpose: Effective mentorship is a contributing factor to academic and workplace success in medicine, yet medical trainees from underrepresented / minoritized groups in medicine (UMGMs) often struggle to find mentors who are from similar social backgrounds. There is a lack of research on equity-based mentorship programs for UMGMs, especially in the Canadian context. To help address these gaps, the University of Toronto Diversity Mentorship Program (DMP) pairs 1st and 2nd year UMGM mentees with staff mentors who ideally share a similar social identity to foster equity-based mentoring relationships. Summary of the Innovation: In 2018-2019, the DMP facilitated 52 mentor-mentee matches, forming pairs that were to meet throughout the academic year. We also offered structured events centered around the theme of equity-based mentorship, creating additional opportunities for learning and networking. The DMP centers around three main objectives: fostering identity development, strengthening community, and empowering excellence. We distributed an online survey to DMP mentors (response rate: 56%) and mentees (response rate: 44%) to learn more about their experiences, assess goal achievement, and highlight the DMP's strengths and weaknesses. Conclusion: High proportions (>85%) of mentors and mentees felt they had productive mentoring relationships. Four in five mentors (79%) also found the DMP to be personally rewarding. The DMP provides a framework for an effective mentorship program for medical students belonging to UMGMs. Our data highlights activities, discussion topics, and techniques used by mentor-mentee pairs, showing that many goals of the program were achieved. We are continually enhancing the program based on feedback to better achieve objectives., Background/Purpose: Physician thinking error comprises 75% of the diagnostic errors in medicine. Six strategies have been identified for enhancing clinical reasoning, including: rationality, metacognition, critical thinking, lateral thinking, distributed cognition and the humanities. This humanities-based workshop was incorporated into the critical thinking curriculum as part of the Med 2 skilled clinician program at Dalhousie University. Summary of the Innovation: Students were provided with an understanding of dual processing theory and cognitive bias through an online podcast and two journal articles. The six strategies felt to enhance clinical reasoning were outlined in a didactic teaching session followed by an interactive workshop utilizing film, visual art and medical readers theatre. Prompt questions were used to engage students in discussion around the types of clinical reasoning skills that can be acquired through each medium. All of the Med 2 class participated, and tutors found them engaged and open to this style of learning. Students completed feedback forms, reflecting on their response at the end of the workshop and how they felt before participating. Comments were overall positive, the experience enjoyable and many changed their perception around the use of the humanities, critical thinking and the importance of communication. Conclusion: The humanities offer opportunities to develop flexible thinking, an appreciation of others' perspectives and an understanding of the importance of cognitive bias. Students were enthusiastic about the workshop and enjoyed the different format. Similar workshops will be integrated into the skilled clinician program in all years., Background/Purpose: Clinicians use probability estimates to make a diagnosis. Teaching students to make more accurate probability estimates could improve the diagnostic process and, ultimately, the quality of medical care. Objective: To test whether novice clinicians can be taught to make more accurate Bayesian revisions of diagnostic probabilities using teaching methods that utilized explicit conceptual instruction or repeated examples. Methods: A randomized intervention of two methods for teaching Bayesian updating and diagnostic reasoning. 3rd and 4th year medical students at McMaster University and Eastern Virginia Medical School (n=61). Students were randomized to 1) receive conceptual instruction on diagnostic testing and Bayesian revision (Concept group), 2) exposure to repeated example cases with feedback on posttest probability (Experience group), or 3) Control group. All groups were tested on their ability to update the probability of a diagnosis based on either negative or positive test results. Their probability revisions were compared to posttest probability revisions that were calculated using Bayes Rule and known test sensitivity and specificity. An effect size was calculated to measure how close students matched the calculated revision. Results: Probability estimates of students in the Concept group were significantly closer to calculated probability as demonstrated by the smaller effect size (Concept=.189, Experience=.289, Control=.301, p, Background/Purpose: Findings from cognitive psychology suggest that high levels of anxiety can impair cognitive processes. In particular, anxiety may be associated with prematurely closing one's diagnostic search. The objective of this study was to determine the influence of anxiety on the risk of premature closure errors in medical students. Methods: Students were asked to rate the probabilities of particular diagnoses across 8 clinical cases, each which were designed to have 2 competing diagnoses that were equiprobable. While the same information was presented to each participant, the order in which features indicative of each diagnosis was presented was manipulated to determine the influence of information order on the probability ratings assigned. Students were randomized to an anxiety induction arm approximating the context of a high stakes examination setting or an anxiety reduction arm. Results: The probability ratings indicated a significant primacy effect, and students in both arms strongly favored the diagnosis presented first (m=37.7 vs. 30.4; p=0.002). This was true both when the diagnoses were generated by the student (m=51.5; 95% confidence interval [CI] 48.8-54.1 vs. m=35.4; 95% CI 32.7-38.1; F= 49.2; d=2.6; p, Background/Purpose: Despite being a considered a core aspect of a health professionals practice, little consensus exists regarding what clinical reasoning 'is'. The purpose of this research was to synthesize explicit definitions of clinical reasoning from health professions education literature to better support the development of teaching and assessment strategies for clinical reasoning. Methods: Papers were identified through systematic searches of five databases, with screening occurring in teams of two, and represented 18 health professions. Within the 625 papers included in the review, we identified 96 explicit definitions, and analyzed the data descriptively and inductively. Results: Three main findings emerged. 1) Commonalities across definitions were: clinical reasoning is fundamental to successful clinical practice, it is a type of thinking applied to health contexts, towards the goals of diagnosis, treatment, prescription, and improved patient care. 2) Definitions different along: what clinical reasoning is dependent on (e.g. cue recognition), executed through (e.g. deliberation), and towards the goal of (e.g. generating and testing hypotheses) and 3) Clinical reasoning was made up of different component parts across definitions (e.g. cue acquisition, hypothesis generation, cue interpretation, and hypothesis evaluation. Conclusion: The 96 definitions converged on the importance of clinical reasoning in clinical care, the reliance on thinking applied to health contexts, and the ultimate goal of clinical reasoning as better patient care. However, they differed significantly - both within and across professions - in how clinical reasoning is executed, observed, and understood. These findings suggest the likely presence of different understandings, or conceptualizations, of clinical reasoning are at play in the literature., Background/Purpose: One of the challenges when assessing and offering feedback to residents is lack of under-standing of the meta-tasks shaping clinical encounters. While most are familiar with the clinical tasks (history taking, physical examination, etc), few are familiar with the reasoning tasks that shape how we take histories, do physicals, or engage in decision making. In a prior study, we identified 24 reasoning tasks that physicians may engage in during clinical encounters. The purpose of this study was to use ambulatory clinic setting to identify reasoning tasks ad-dressed by residents and those introduced by faculty. Methods: Data consisted of audio-recorded case reviews between attending physicians and PGY1-5 residents. Transcripts were analyzed using validated reasoning tasks and constant comparison approach. Results: On average, 10 reasoning tasks were addressed/encounter. New consults focused more on tasks of identifying most likely diagnosis and establishing management plans. Follow-up en-counters focused on assessing rate of progression, response to treatment, estimating prognosis, and determining follow-up. Tasks refined by factually included weighing alternative treatment options, identifying complications associated with treatment, and assessing response to treatment. Conclusion: These findings can be used in three ways: First, the common patterns of reasoning task omis-sions can be shared with residents for better preparing them for their ambulatory encounters. Second, having a shared language around the metacognitive tasks shaping the encounter can allow for more meaningful feedback with residents. Finally, as we move forward, reasoning tasks can be used in the design of assessment instruments in the era of competence-based training., Background/Purpose: To act with confidence while simultaneously remaining uncertain is a paradox that epitomizes expert practice. Yet how experts comfortably navigate complex, ill-defined problems remains poorly understood. We sought to examine the behaviors of experts who work in settings rife with uncertainty, exploring what they do to work “comfortably” despite lingering uncertainties. Methods: We employed a constructivist grounded theory approach to explore experiences of uncertainty in emergency medicine faculty. We used a critical incident technique to elicit narratives about decision-making immediately following participants' clinical shifts, exploring how clinicians made judgments about whether problems were within their scope of practice, when they felt compelled to enlist others' help, and how they determined when a problem should be triaged to others. Two investigators analyzed the narrative transcripts, coding data line-by-line using constant comparative analysis to organize transcripts into focused codes, key conceptual categories, and then major themes. Results: Participants identified multiple forms of uncertainty, organized around conceptualizations of the problem they were facing and the actions they would consider taking in those moments. They described iterative cycles of forward planning and monitoring that generated variable levels of comfort with the situation. This spectrum of comfort in led to a variety of responses: owning the problem with comfort, co-owning the problem with others, triaging the problem to others, or moving forward despite discomfort. Summary: We describe emergency physicians experiences with uncertainty: how they identify the different forms of uncertainty, how they experience and manage these uncertain moments, and the multitude of ways that they respond to these moments of uncertainty. These results provide language around what clinicians mean when they say that they are “comfortable” working through clinical problems while simultaneously experiencing uncertainty. Conclusion: Clinicians experience multiple forms of uncertainty. Their multitude of potential responses are informed by variable levels of comfort that result from real-time self-monitoring and forward planning., Background/Purpose: In 2017, the University of Toronto's Medical School launched BSAP, an optional application pathway, to address the longstanding rates of low admissions and enrollment of Black students. In addition to meeting other mainstream prerequisites (MCAT, GPA, courses requirements, and admissions panel interviews), BSAP applicants submit an additional BSAP specific essay and complete interviews with Black physicians and/or communitymembers. Methods: This mixed-methods evaluation uses a critical realism paradigm and a community participatory social justice framework to a) explain historical background and discriminatory practices against Blacks of African descent that have negatively impacted equitable outcomes even in medical school admissions practices and enrollment numbers, b) provide trend data from 2009 - 2017, prior to BSAP, as evidence of long-time low enrollment numbers of Black medical school students, and 3) provide narrative feedback from the 2018 cohort of BSAP students to discuss perceptions of BSAP and community support as evidence of positive outcomes. Results: Trend data based on unofficial numbers of Black medical school alumni between 2009- 2017 (n= ~40) are reported. Of the 14 students in the 2018 BSAP cohort, findings are based on outcomes of 16 pre- and post-interviews with 8 student participants. We will use a thematic analysis to report on participant experiences, identified barriers and enablers, and future factors affecting BSAP outcomes. Conclusion: BSAP has effectively increased Black medical school enrollment at the University of Toronto and with continued community support will produce longitudinal success for participants and the medical school community at large., Background/Purpose: Despite perceived benefits of diversity, medical students from affluent and highly educated backgrounds are overrepresented in Canadian medical schools. Little is known of the medical school experiences of students who are first in their family (FIF) to attend university. Methods: All medical students in years 2, 3 and 4 were invited to participate in an interview to discuss their social background and medical school experiences, if they identified as first generation in their family to attend university in Canada. In order to better understand how their background influenced FIF medical student experiences, we also interviewed 6 students who identified as being from medical families for contrast. Bourdieu's concepts of habitus and capital were used as sensitising concepts to explore the data. Results: Participants brought up issues of (not) feeling like legitimate medical students, tensions inherent in navigating their pre-medical life with their newly adopted identity as medical students, and how capital influences both the admissions process and experiences at medical school. Conclusion: FIF medical students may continue to face challenges and disadvantages during medical school due to the social and cultural norms of the medical field. The results of this study provide insight into some of the ways that the medical school culture can make underrepresented groups, whom we seek to attract, feel marginalized. In doing so, this study also highlights possible ways for medical schools to further embrace the experiential knowledge and diversity that FIF students bring., Background/Purpose: The University of Toronto's Postgraduate Medical Education (PGME) office aims to develop a Diversity Mentorship Program (DMP) to connect underrepresented/minoritized residents (UMR) to mentors who could support them in their educational and professional development. We conducted a survey of existing diversity-based mentorship programs and a survey of residents to gain their perspectives on mentorship. Methods: Two separate online surveys were administered, one to all 98 Program Directors (PD) with a 91% response rate (n=89) and another to all 2044 residents which had a 35% response rate (n=719). PDs reported existing diversity-based mentorship opportunities in their programs. We examined residents' experience with previous mentorship, and perceptions of the proposed DMP and features of an ideal mentorship. Results: PDs reported that 9 residency programs currently offer diversity-based mentorship opportunities. Among participating residents, 28% were UMRs. Among UMRs and non-UMRs, 29% and 25% respectively reported to lack mentors. Of UMRs without a mentor, 74% would like one. Nine in 10 UMRs (87%) expressed interest participating in a DMP and wished for the following components: 1) Career advice/networking and 2) Discussing minority experience/overcoming barriers. UMRs valued frequent meetings with mentors open to online communications, and preferred mentors from a similar minority group. Conclusion: The difference in mentorship rates between URMs and non-URMs is negligible. The lack of diversity-based mentorship opportunities for residents and UMRs' desire to participate in one indicate the need for a PGME-wide DMP., Background/Purpose: Substantial literature demonstrates disparities between men and women physicians that consistently disadvantage women. These inequities have been demonstrated persistently over decades without improvement despite awareness. We sought to understand perceptions and experiences of gender equity in a single academic internal medicine department. Methods: We conducted a sequential explanatory mixed methods study. The quantitative strand consisted of a department-wide survey using the Culture Conducive to Women's Academic Success instrument. This was followed by semi-structured interviewing of all department members who volunteered to participate. Interviews were coded inductively by two reviewers using thematic analysis guided by constructivism. Results:167 department members completed the quantitative strand (42.9% response rate; n=100 women (57.1% response rate among women), n=67 men (25.1% response rate among men). Men department members perceived the culture of the department toward women as significantly better than women themselves. There were 28 participants in the qualitative strand (7.2% response rate; n=22 women (12.9% response rate among women), n=6 (2.8% response rate among men). We identified two major themes (Parenthood & Caregiving and Leadership & Promotion) that were mediated by two experiences (Harassment & Discrimination and Exclusion). Men department members perceived equity and did not report experiences of inequity while women department members perceived and experienced inequity in the department. Conclusion: Men and women department members differ in perceptions and experiences of gender inequity. This gap in understanding the barriers and disparities experiences by women colleagues may explain persistence of inequity over time, as many senior leadership positions are held by men., Background/Purpose: Links between medical student wellbeing, learning and performance are worldwide concerns. Heightened concerns at reports of self-harm and suicide, accreditation standards, legal and policy requirements reiterate medical school obligations to support the learning and welfare of struggling students, and to ensure all graduates are well versed in self-care. Yet, there is little attention to the impact of these obligations on the staff who provide this support. We conducted a series of studies to investigate the personal impacts and professional development implications of student support roles on academic and professional staff. Summary of the Innovation: Using Design-Based Research, successive waves of data collection, analysis and implementation of findings in training interventions were conducted between 2011-9 at four medical schools in Australia, Sri Lanka and Malaysia. Data included 51 interviews and 181 questionnaire responses from professional and academic staff and medical student participants. Thematic analysis, informed by Emotional Labor and Positioning Theory, was conducted on qualitative data. Quantitative data were analysed descriptively. Conclusion: For professional staff, support work was informal and not well recognised. There were positive impacts, but also prolonged distress after emotionally laden encounters. Academic staff described adopting diagnostician, judge and confidant positions, positioning students as good or troubling, depending on the circumstances and context of the support encounter. In diverse international contexts, participants expressed similar obligations to provide support and preferences for training in support. Structural and cultural differences limiting transfer of some support practices were identified. Opportunistic, theoretically informed design-based research, sensitive to contextual nuances and triggers, can generate transferable research outcomes to address universal problems., Background/Purpose: The final report of the Truth and Reconciliation Commission of Canada: Calls to Action was published in 2015. The Calls to Action number 23 states, “We call upon all levels of government to: i. Increase the number of Aboriginal professionals working in the health-care field. ii. Ensure the retention of Aboriginal health-care providers in Aboriginal communities. iii. Provide cultural competency training for all health-care professionals.” The goal of the program is to increase the number Indigenous medical students and physicians in British Columbia. The program's vision was “A Total of 50 Indigenous medical students graduate from UBC's Undergraduate MD program by 2020.” We will present the successes and challenges of our program. Summary of the Innovation: Conducted a literature review by reviewing other medical school programs in Canada and the USA. Conducted one-on-one interviews with other UBC Indigenous programs such as Faculties of Law and Education. Community and student forums also provided feedback on the support and recruitment programs. Data on the number of applicants, enrolment and graduates are recorded on annual basis. The University Of British Columbia Faculty Of Medicine developed an Indigenous program that supports the recruitment, mentorship, and facilitated admission of Indigenous premedical undergraduate students for entry into the MD program. It also provides personal, cultural and academic support for medical students entering the MD program. The highlights of the program includes the Indigenous MD Preadmissions Workshop (recruitment), Indigenous MD Orientation Days (support) and the Indigenous Medicine Cousins Mentorship Program (recruitment/support). Conclusion: The program currently has forty Indigenous medical students in its entire four-year program. Eleven Indigenous medical students graduated in May 2019, which was the faculty's second largest class of Indigenous graduates. To date, ninety-one Indigenous physicians have graduated. Sixty five percent of graduates were/are trained in Family medicine while the remaining were/are trained in other specialties and subspecialties. We found it was crucial to consult other programs and medical school who already had programs in place to avoid “re-inventing the wheel.” Need support from Indigenous communities who will be providing the students. During the first five years of the program, it became apparent that the designated admissions process was not sufficient, and it concluded that support from the Student Affairs and the Undergraduate MD Education offices were vital to the success of the program. UBC's Faculty of Medicine is seen as one of the leaders in increasing its numbers of Indigenous physicians., Background/Purpose: It is well-established that Indigenous Peoples across Turtle Island (North America) experience significant health disparities, compared to the general population. The ongoing effects of colonization and institutional racism are core contributing factors to this inequity. It is important to encourage medical students to critically examine why the determinants of health exist, rather than accept them as inevitable. The KAIROS Blanket Exercise (KBE) has the potential to achieve this goal. Summary of the Innovation: The KBE is an immersive, interactive exercise where participants move among blankets representing the land and walk through major events in Indigenous history. This is followed by a guided debrief, in the form of a talking circle. The KBE has great potential for transformative learning, and we therefore set out to elicit the impact that participation in the KBE had on medical students. In February 2018, 213 second-year medical students at the University of Toronto participated in the KBE, and 174 subsequently completed a voluntary paper evaluation. Data were analyzed by quantitative and qualitative methods. Conclusion: Analysis of the evaluation revealed that participation in the KBE led to shifts in the way students viewed those from backgrounds different from their own, and encouraged reflection on the biases and stereotypes they held regarding Indigenous Peoples, as well as their position of privilege and power. Central to this transformation was the role of critical reflection through authentic dialogue, and revealing the complex socio-political context of Indigenous Peoples' history. This suggests that creating space for transformative educational experiences in medical curricula may foster perspective-shifting, ultimately leading to the development of reflexive practitioners., Background/Purpose: The 2015 Truth and Reconciliation Commission (TRC) 94 calls-to-actions bring attention to the pervasive injustices and institutional racism faced by the Indigenous people of Canada. As a result, institutions across Canada have discussed decolonization and indigenization strategies. Decolonization is a complex multifaceted term that involves restoring Indigenous views, culture, knowledge, and traditional values. This project focuses on decolonization from an educational and healthcare standpoint. Methods: The inaugural Decolonizing Healthcare Congress Day was co-organized by students from graduate studies, nursing, and medicine. The event was attended by community members (including a local Indigenous Elder), students, researchers, educators, faculty, and health practitioners from diverse backgrounds. The event was opened with a paired keynote session which provided context for the importance of engaging in the decolonization of healthcare from an Indigenous and non-Indigenous perspective followed by small group discussions. Attendees participated in three breakout sessions over the remainder of the day, before coming back together as a large group. Results: Attendees had the opportunity to hear from the speakers as to how decolonizing health is a part of their work. The majority of the breakout sessions were spent in group discussion, learning and teaching each other. The day ended as a large group, providing an opportunity for sharing reflections, thoughts, and plans for the coming months and years as to how decolonizing can take place on an individual level within our learning and practices, and on institutional levels. Conclusion: The organizing committee plans to develop a Decolonization task force aimed to address the key takeaways from the event. Notably, we hope to engage senior leadership of our school to help us implement change. Some of the suggestions include the introduction of anti-racism workshops for students, faculty and staff at our institution, inclusive sacred spaces, knowledge sharing practices, and holistic review of applications to post-secondary. Suggested future strategies for increasing Indigenous health research capacity includes evaluating current application standards and recruiting practices in post-secondary health fields., Background/Purpose: The Truth and Reconciliation Commission of Canada has called upon all levels of government to increase the number of Indigenous professionals working within the healthcare field. In response, medical schools have undertaken initiatives to address application-specific barriers to pursuing medical education. These initiatives overlook upstream barriers that Indigenous peoples face in the pursuit of healthcare education. Summary of the Innovation: Over several years the Indigenous MedLINCs program, through the Office of Distributed Education at the Schulich School of Medicine & Dentistry has coordinated the delivery of engaging, healthcare-related programming to Indigenous youth in Neyaashiinigmiing. Continuity of the relationship the medical school has fostered with the community has created an opportunity for youth and community members to explore their interest in healthcare professions. Programming includes aspects of wilderness first aid, suturing, and casting. Conclusion: Beyond hands-on learning, these activities help create discussion and action around the perceived barriers to post-secondary education for Indigenous youth. By sparking an interest in healthcare and building confidence and self-efficacy related to helping, we believe that youth who take part in our programs will be more likely to consider a career in healthcare. Using a novel method we administered pre- and post-programming surveys and measured an increase in both interest in healthcare (18% increase) and helping-related self-efficacy (45% increase). The relationship that Schulich has built with its neighbouring Indigenous communities can be used as a model that can be adapted by medical schools across Canada in an effort to establish pathways and opportunities for Indigenous youth to consider careers in healthcare., Background/Purpose: The integration of Indigenous healing knowledge and practices into biomedical settings is complicated by Canada's history of colonialism, which included the banning of Indigenous medicines and healing ceremonies until the 1970's. While the recent Truth and Reconciliation Report recommendations for recognizing the value of Indigenous healing practices and increasing access appear to be steps in the right direction, critical scholars argue that without more significant changes in settler-Indigenous relations, these moves may simply work to hide the ongoing influence of colonialism and obscure the impact of biomedical dominance on indigenous practices. Methods: This paper presents early work from my doctoral study which examines the use of the Two-Eyed Seeing principle to theorize the integration of Indigenous medicines into health care setting while employing Indigenous, decolonizing methodologies including Indigenous First Voice. Exploring my identity as a woman with mixed ancestry (Metis, Mi Kmaq, French/Scottish and simultaneously coming to terms with a recent stage two cancer diagnosis, I will reflect on my own 'living' experience of navigating the tensions between using Indigenous medicines alongside biomedical care for cancer care. Two-Eyed Seeing is a Mi'Kmaq principle which involves “learning to see from one eye with the strengths of Indigenous knowledges and ways of knowing, and with the other eye with the strengths of Western knowledges and ways of knowing, and learning to use both these eyes together, for the benefit of all” (Bartlett, Marshall and Marshall, 2012, pg. 337). Results: Two Eyed Seeing has the potential to provide a path for honouring Indigenous Peoples history, while moving towards reconciliation, by also keeping in mind Canada's colonial past, and simultaneously looking forward to a future where Indigenous healing practices can be valued and preserved without becoming biomedicalized. Conclusion: Two-Eyed Seeing is one of many Indigenous epistemologies geared toward decolonizing healthcare practices in Canada (e.g. Iwama et al, 2009; Martin, 2012). However, the limitation is that, like biomedicine with its mind-body dichotomy, the Two-Eyed seeing concept splits the world into simplified categories of “indigenous” and “non-indigenous” and negates the impact on colonization, and market capitalism, on how knowledges are shaped., Background/Purpose: Université de Montréal organizes Mini-Schools (MS), during which voluntary undergraduates of health sciences visit indigenous youth and exchange about health topics. Undergraduates take part to a pre-departure training one week before the MS. The MS last one day (Wemotaci) or one week (Côte-Nord). This study aims to assess the impact of these activities on undergraduates' prejudices toward indigenous people. Methods: Undergraduates completed the Old-fashioned and the Modern Prejudiced Attitudes Toward Aboriginals Scale (O-PATAS and M-PATAS) before the training (baseline), after the training (T1) and after the MS (T2). Scores were compared using repeated measures ANOVA. Results: Among the 70 participants, 49 filled the questionnaire at baseline, T1 and T2 (70% participation rate). They were from 11 health & social sciences programs, 77.6% were women, mean age was 21.8, 36.7% were in medicine, 24.5% in nursing. There was a significant reduction of prejudices as measured by the O-PATAS (Baseline 23.1 ± 5.9, vs. T1 22.4 ± 5.5 vs. T2 18.9 ± 5.6; Intervention effect: F (2, 96) = 12.4, p < 0.001). The reduction was significant at T2 (F(1,48) = 12.7 p=0.001), but not at T1 (F(1,48) = 0.7 p=0.4). Likewise, there was a reduction of prejudices as measured by the M-PATAS (Baseline 23.2 ± 6.0, vs. T1 23.6 ± 6.2 vs. T2 21.1 ± 5.5; Intervention effect: F (2,96) = 5.3, p =0.009). The reduction was significant at T2 (F(1,48) = 7.9 p=0.007), but not at T1 (F(1,48) = 0.5 p=0.5). Conclusion: In a group of voluntary undergraduates in health and social sciences, opportunity for exchange with indigenous communities, but not theoretical teaching, appears to reduce prejudices. Maintenance of such changes over time remains to be eluded. OC 1-1 Forecasting future clinical performance: The value of MMI selection interviews in predicting clinical competence in senior medical student OSCEs Kylie Mansfield University of Wollongong, Lyndal Parker-Newlyn University of Wollongong, Helen Rienits University of Wolllongong, Kelly Dore McMaster University Background/Purpose: Previous academic results predict future academic performance and are widely respected admissions measures, despite weaker correlation with clinical aptitude. Predicting clinical performance, is arguably a more important goal in medical school admissions - is MMI a better tool for predicting competence? Methods: Selection scores from six cohorts of MD students (2007-2012) were correlated with all in-course assessments. Specifically, predictive validity of admission MMI vs final year OSCE was assessed (N=409). Attribute matched MMI scores from two cohorts of MD students (2016-2017 graduates) were correlated with OSCE domains of competence using linear regression and correlations disattenuated. Results: GPA demonstrated significant correlation with academic performance in Yr1 written examinations (R=0.12, P, Background/Purpose: The epidemic of candidate cheating within high-stakes testing contexts is perhaps particularly worrisome within the medical licensure field where assessments serve predominantly as gatekeepers for public protection. The popular Objective Structured Clinical Examination or OSCE test format used within this field heightens the risk of candidate cheating via ease of information sharing prior to the examination. At the same time, tracking shifts in item parameters over time, a phenomenon commonly known as item parameter drift (IPD), to help detect potentially exposed test content is further complicated in OSCE settings, given the variance associated with the need for examiners to assign scores. The advancement of the Multi-facets Rasch model (MFRM) to allow test environment factors to be included directly within the model may perhaps offer a convenient solution to this judge-mediated setting for the calculation of case estimates that are more reflective of the context. Methods: This study specifically applied a four Facet MFRM to investigate IPD patterns of 36 high-stakes OSCE cases administered over several administrations. Results: Results revealed patterns of significant IPD in terms of increased case easiness in eight of the 36 stations (22%), indicating potential exposure. Conclusion: Retirement of these cases is recommended and the adjustment of candidate scores based on these results warrants further investigation. The generated difficulty estimates for the remaining 22 cases provides a convenient system for tracking and monitoring IPD patterns in future administrations., Background/Purpose: The concept of entrustment has been shown to be useful in the assessment of trainees in a competency-based educational model. However, very little is known about the role of entrustment in performance-based assessment. The purpose of this study was to explore the use of an entrustment-aligned rating scale within the context of an OSCE progress test. Methods: A 9-case OSCE progress test was administered to Internal Medicine residents (PGY 1 - 4). Residents were assessed using a checklist (CL), a global rating scale (GRS), a training level rating scale (TLRS) and an entrustability scale (ENT). Reliability was calculated for each measure using Cronbach's alpha. Correlations between scores using the different rating instruments were calculated. Differences in performance by year of training were explored using ANOVA and post hoc Tukey's HSD test. Examiners completed a survey regarding the different rating methods. Results: Ninety-one residents and 42 examiners participated in the OSCE. Inter-station reliability was greatest using TLRS (0.83) compared to the ENT (0.79), GRS (0.77) and CL (0.74). Scores from the different rating instruments were highly correlated (range 0.85 to 0.93; p < 0.01). The average ENT score increased by training level (2.69/5 (PGY1) to 3.80/5 (PGY4)) but was statistically significant only between junior residents (PGY1/2) and senior residents (PGY3/4), p < 0.0001. 88% (n=37) of examiners completed the survey. Most preferred the ENT over other scales. Most (64%) indicated feeling comfortable in making entrustment decisions during the OSCE. Conclusion: Entrustment scores were found to have high reliability and demonstrated significant differences in OSCE performance by level of training. This supports the incorporation of entrustment scales in OSCE progress tests., Background/Purpose: Most CBME assessments are intended to be workplace-based; however, OSCEs are still a part of the assessment framework. Borderline regression standard setting for OSCEs uses a global rating scale with anchors such as poor, borderline, good, etc. This contrasts the entrustment scales used in CBME workplace-based assessments. The purpose of the study was to compare a traditional global scale to an entrustment scale in terms of reliability across stations and impact on pass/fail decisions. Methods: The University of Alberta Internal Medicine residency program uses the O-SCORE entrustment scale for workplace-based assessments. In the spring of 2019, we added an adapted O-SCORE (e.g. I would have had to prompt) to our first-year resident OSCE in addition to our usual checklists and rating scales, including our six-point global rating scale (anchors Very Poor, Poor, Fair-Borderline Fail, Fair-Borderline Pass, Good, Very Good). We looked at correlations between, reliability across all stations, and consistency of pass-fail decisions for our six-point scale and the adapted O-SCORE. Results: Correlations between the global scale and the O-SCORE were moderate to high depending on the station, reliability across stations was very similar, but the O-SCORE led to a higher cut score with 29% of pass decisions changed to a fail. Conclusion: The adapted O-SCORE may not measure the same construct as our traditional global scale for some stations and led to a higher cut score with this scale. OSCE developers should be aware of the impact of directly substituting an entrustment scale for a traditional global scale., Background/Purpose: There is increasing interest in the use of assessments to enhance student learning and improve performance. However, there is limited understanding of the range of factors that influence the utility of such efforts. This study examined factors influential in how students were learning through OSCEs and identified the key role of emotional state in students' self-regulation of learning. Methods: Using principles of Constructivist Grounded Theory, first-year medical students were interviewed about their experience learning in the context of a summative OSCE (N=21) and a formative OSCE (N=15). Results: Students' efforts at learning in the context of the OSCEs was driven by personal objectives related to improving performance, but also by objectives related to achieving a positive emotional state. Students' emotional state was influenced by interactions between factors related to the student (e.g., time management skills), the assessment design (e.g., the presence of academic consequences) and the broader learning environment (e.g., concurrent educational tasks). In some cases, students who prioritized improving their emotional state did so at the expense of improving their performance because the strategies used to address emotional state and performance objectives were contradictory. In other cases, the strategies students used were complementary and thus, improving their emotional state did not negatively impact performance improvement. Conclusion: Students' focus on improving their emotional state in OSCEs was sometimes detrimental to their objectives related to performance improvement. To support students' self-regulation of learning through assessments, educators may need to consider approaches to minimize negative emotions or help students manage negative emotions more effectively., Background/Purpose: OSCEs are dominant in health professions education (HPE). Such hegemony comes with unintended consequences, which we addressed using critical discourse analysis of interviews with an at times overlooked (and contentiously labelled) stakeholder group: simulated patients (SPs). An earlier study in this programme of research identified SPs as undervoiced in assessment conversations. Participants explored the nature of OSCEs, examining relationships, motivations and dynamics of power. The overall aim of this study was to contribute, critically and constructively, to debate around assessment in HPE. Methods: Study design was iterative, with our critical approach foregrounding interplays of power and positionality. We carried out in depth interviews with a maximum variation sample of eight SPs at a UK medical school. Data analysis was an inductive process which began at data collection and developed through discussion among the research team as we focused on language in use, drawing on Gee's tools. Results: SPs' language directly addressed power imbalances, tensions and contradictions around OSCEs. Participants constructed OSCEs within four discourses of reducing, objectifying, industrialising and making accountable. Conclusion: Tensions around OSCEs (evident in published literature and built on through the voices of study participants in this work) may be explained by conflict around the point of paradigm shift towards a 'post-psychometric' era of assessment. Attending to such tensions might support constructive development of assessment across the breadth of HPE., Background/Purpose: Interprofessional education (IPE) is valuable for students in health care and other undergraduate disciplines, and the Liaison Committee for Medical Education mandates IPE be a part of the undergraduate medical curriculum. We suggest that an IPE event that exposes students to a breadth of mindsets through peer-to-peer education and mentorship, including those who are not from health care backgrounds, can encourage the growth and development of future health care professionals. Summary of the Innovation: We created a weekend-long Interprofessional Challenge (IC), bringing together learners from every faculty across our University to work on a healthcare-related grand challenge. The event was piloted in 2016 with 35 students, and has brought together over 100 students in subsequent years. Unlike traditional hackathons where the focus is on creating a “winning idea”, we focus on providing students with the opportunity to learn with and from students from other faculties, while pursuing a common goal. Educational activities include brief presentations from each faculty on problem-solving, concurrent workshops on challenge-related topics, a “help-desk” of mentors, a “pitch clinic” and a pitch competition. Conclusion: Feedback from the students, faculty, mentors and judges has been overwhelmingly positive and has led to every faculty at the University providing funding for subsequent years' events. Students valued the unique opportunity to create tangible solutions to real-life issues in a pre-determined interprofessional team. On average, students were “very likely” to both recommend (4.7/5) and attend (4.5/5) this type of event in the future. Our plans for the IC include expansion to other universities., Background/Purpose: La pratique réflexive est nommée comme étant une approche à considérer pour soutenir le développement des compétences à la collaboration interprofessionnelle (CIP). Peu de littérature existe cependant à ce sujet et les initiatives de pratique réflexive en CIP sont souvent peu opérationnalisées et non fondées théoriquement. Considérant l'importance de la CIP et les enjeux rencontrés dans son enseignement, notre équipe s'est penchée vers le développement d'une approche de pratique réflexive basée sur la littérature et ancrée empiriquement. Summary of the Innovation: Les fondements théoriques de l'approche développée ont été assurés par une recension réaliste des écrits sur la pratique réflexive en FIP, un relevé exhaustif de littérature sur la pensée critique en santé et services sociaux, ainsi que des rencontres de validation auprès d'experts du domaine. La validation de l'approche s'est poursuivie empiriquement par l'analyse de discussions interprofessionnelles entre étudiants et par des groupes de discussions focalisées avec des formateurs en CIP. L'approche développée consiste en un enseignement explicite des formes de base du raisonnement logique et de certaines habiletés de pensée favorables à la CIP, puis à la mise en pratique des apprentissages dans le cadre de discussions cliniques entre étudiants facilitées par des personnes ressources formées. Les outils développés, issus de la logique formelle et informelle, ont été expérimentés dans le cadre d'un cours de CIP offert auprès d'étudiants de six Facultés de l'Université Laval. Conclusion: L'enseignement explicite et l'utilisation du raisonnement logique et des habiletés de pensée en CIP sont des stratégies qui favorisent le développement de compétences à la collaboration telles que la communication interprofessionnelle, le leadership collaboratif, la résolution de conflits et le travail d'équipe. La rigueur du dialogue qui en découle permet également de discuter des cas cliniques dans une perspective centrée sur les besoins de la personne et de ces proches., Background/Purpose: Faculty Development (FD) utilizing inter-professional small groups is uncommon. At the University of British Columbia, we implemented a longitudinal FD program where faculty from various health professions taught and learned from each other. We sought to understand how the inter-professional setting impacts teaching and learning in FD. Methods: Four cohorts of five participants each, met for six, 90-minute sessions that were moderated by FD leads over one year. Each participant developed and delivered an interactive lesson on a key educational topic. Participants gave structured feedback; dialogue and reflection were encouraged. A safe space was actively promoted through modeling of respectful, collaborative communication by the facilitator, corresponding ground rules and a focus on educational topics. Interviews were conducted with three participants and four cohort leaders. Preliminary content analysis was conducted by two of the authors by coding the transcripts and identifying themes. Results: Participants reported feeling safe in sharing their experiences and perspectives more freely in these groups than in their own uni-professional groups. They began to appreciate commonalities and variations in how health professions applied educational principles. They took into consideration the needs and perspectives of other professions when planning lessons, resulting in a fresh approach. Over time, the feedback and discussions became robust, and participants incorporated the observed learned strategies in their own practices. Conclusion: Longitudinal FD in small groups with active participation of inter-professional faculty in a safe environment promotes a deeper understanding of how other professions teach and work and enhances the feedback process., Background/Purpose: Professional Development (PD) events (Faculty Development and Continuing Professional Development) are key components of clinically upskilling and maintaining the teaching capacity of faculty in Health Science programs. A typical needs assessment ascertains the relative strengths and gaps in faculty knowledge. We flipped this notion to determine how well PD providers know what motivates their clientele to attend PD events. Methods: An online survey combining open-ended and Likert-items asking about motivations to attend PD Events was performed and received 204 responses across our nursing, rehabilitation therapy, health science, and medicine faculty. Response rates averaged around 15% and proportions of responses were representative of the sizes of each health professions' faculty roster. Results: There were no significant differences between types of Health Professions Educators and their relative emphasis on a given motivator. The strongest reported motivator for attending a given FD event was “interest in the content”, while the lowest reported motivator was “Continuing Education credits” and their equivalents. Topics that were seen as strongly contributing to competence as a health professional and teacher occupied the middle of the range of importance as drivers. Conclusion: Nothing surpasses topics of interest as a main driver of attendance at PD events but clear arguments for how the PD event will improve healthcare provision or teaching ability are closely related to an increase in attendance. Although accreditation is a key component of ensuring quality, evidence-based education, credits and equivalent extrinsic incentives such as nice venues, or time-condensed events were reported by Faculty to very weakly motivate them., Background/Purpose: Research demonstrates that debriefing is a key aspect of simulation-based learning and that debriefing quality impacts student learning. While many characteristics of debriefing have been elucidated, the impact of interprofessional (IP) co-debriefing on student learning has not been investigated. Therefore, we explored the effect of IP co-debriefing compared to single facilitator debriefing on TEAM questionnaire scores among students participating in a simulated disaster. Methods: Pre-licensure healthcare students were randomly assigned to IP groups. Student then triaged and cared for standardized patients portraying victims of a mass casualty. Teams completed their first simulation scenario and were subsequently debriefed by one or two facilitators. Students then participated in a second scenario with their same group. In total, 369 students (i.e., 152 medical, 157 nursing, 44 respiratory therapy, and 16 paramedicine students) participated. Debrief facilitators included faculty and clinicians from medicine, nursing, respiratory therapy, medical laboratory technology, and radiation technology. To evaluate student teamwork performance, the Team Emergency Assessment Measure (TEAM), a previously validated assessment measure of teamwork during medical emergencies, was completed by facilitators and students. Results: Facilitator ratings of student team performance in the two scenarios improved significantly for students assigned to single-facilitator debriefing in their first scenario, (39.58 to 50.44, p, Background/Purpose: Contemporary healthcare teams are complex and dynamic. Team members frequently encounter challenges that require seeking assistance from inside and outside the team. Despite how commonly help-seeking behaviours are encountered, understanding the complexities in the provision and receipt of help within interprofessional teams is underdeveloped in the health professions education literature. The experiences of other team-based professions, such as business and engineering, might offer insight into these challenges. Methods: We undertook a scoping literature review to explore how helping behaviours in professional teams have been studied and are understood. This methodology offers a systematic way to identify, map, and review existing knowledge on helping behaviours, including stakeholder perspectives. Results: Our review suggested two features of helping phenomenon related to the provision or receipt of help within teams: 1) ways that help is defined and enacted, 2) personal, situational, and organizational factors that shape how this occurs. Our review also found a lack of literature that details naturalistic work teams (i.e. not artificially created) in both health care contexts and other professional domains of literature. Conclusion: Understanding helping behaviours is essential to encourage and support optimal functioning of clinical teams. Insights derived from other team-based professions adds to our understanding of how help is sought and provided within teams. This knowledge can influence initial education and professional development initiatives to establish and enhance helping behaviours within clinical teams., Background/Purpose: Patient as Teacher (PAT) programs offer an approach to education that recognizes patient expertise and engages patients in the medical education process. Sharing patient experiences through narratives can create learning and understanding that encourages meaningful dialogue and partnerships between patients and providers. Despite increased adoption in medical education, PAT programs have not been studied sufficiently in the context of surgery. Summary of the Innovation: We report findings from the development and evaluation of a newly established PAT program at University of Toronto. Integrated into third year surgery clerkship, the program consists of 3 interactive workshops with 4 different breast cancer survivors and creation of an arts-based reflection. To explore students' experiences, 5 focus groups with 46 students were conducted at rotation's end. Students reflected on overall program experience, including its impact on their educational practices and identity. Transcripts were analyzed using thematic analysis involving an iterative process of inductively coding data and organizing codes into relevant thematic categories. Students valued protected time to learn directly from the patients, slowing down and focusing on the human side of surgical care and from hearing the experiences the “less victorious” narratives. They learnt the significance of the “the little things” in patient-provider interactions, further developed an appreciation for the individuality of experiences despite the same disease and finally the impact of breast cancer on a person's identity and life. Conclusion: The PAT program successfully promoted and fostered the humanistic side of surgery and is a model that could be incorporated into surgical clerkships throughout Canada., Background/Purpose: Proponents of competency-based medical education (CBME) suggest it may improve patient care and promote greater social accountability to the public and desired outcomes for patients (1,2). Given the rise of patient engagement in healthcare and patient-centered models of care, it is important to understand how patients might define and think about competence and CBME models of training. There is a need to engage patients in the design, delivery, and assessment of CBME to parallel current trends in healthcare. Methods: A convergent parallel mixed methods design was used to simultaneously collect quantitative and qualitative data that converged on the central phenomenon of patient perceptions of competence in medical learners. Participants were adult inpatients admitted to the Medical Teaching Unit at Foothills Medical Centre whose care team involved medical students and residents from the University of Calgary. Results: Between April and August 2019, 82 patients completed a survey and 35 patients completed a semi-structured interview. Patients commonly associated confidence in learners with competence, and felt it was acceptable for learners in difficulty to require more time to complete their training. Medical expertise and communication were perceived as the most important CanMEDS domains, whereas Leadership was seen as the least important domain. Conclusion: Patients were supportive of principles underpinning CBME, largely, that some learners may require more time. Patients prioritized expertise and communication, perceived as confidence, in their assessment of competence. Future research should further explore how patients may be involved in the assessment of learners., Background/Purpose: Funding organizations encourage researchers to involve patients in research. Patients can contribute unique insights that help align studies with patients' needs. In this study we explored the involvement of patients in medical education research (MER). Methods: Using Web of Science, we identified corresponding authors who published MER in English in 2017. We calculated descriptive statistics (i.e., frequencies and percentages) based on the data. Results: Of the 283 respondents, 153 (54.1%) indicated that they involve patients in their MER. Of these respondents, 102 (66.7%) stated that patients are participants (i.e., data sources), 41 (26.8%) noted that patients are involved as advisors/reviewers (i.e., provide guidance to the research team but are not research team members), and/or 22 (14.4%) indicated that patients are involved as research team members (i.e., where they are formally recognized as part of the research team). The 130 respondents who do not involve patients in their MER do not involve them because they believe that their research topic(s) are irrelevant to patients (n=68; 52.3%), they have limited resources to support patient involvement (n=40; 30.8%), and/or they do not know how to involve patients (n=28; 21.5%). Conclusion: Patient involvement in MER, beyond patients as data sources, is slowly emerging. Moving forward, it is important for those working in MER to acknowledge that patients can contribute to study priority setting, the development of research questions, data collection and analyses, or dissemination efforts. Such involvement can improve the quality of MER., Background/Purpose: “Patient as Teacher” (PAT) educational initiatives aim to bring the human experience more prominently into the medical education process by integrating patients and their stories into teaching. Yet despite decades of PAT programs and related research, incongruent perspectives on patients' involvement and motivations can still complicate PAT efforts. The underlying reasons for patient engagement from the perspectives of all PAT stakeholders - particularly patients - requires further scrutiny to ensure meaningful, non-tokenistic PAT programs and avoid potential coercion. Methods: A new Patient as Teachers program was launched in 2018 for undergraduate University of Toronto MD students doing their surgical clerkship. Using a phenomenographic approach, we conducted 21 semi-structures interviews with patient teachers, students and facilitators who participated in this program to investigate the qualitatively various ways the program (the phenomenon) was experienced. Results: Analysis identified different phenomenographical categories of description and how these categories were structurally related. One category may explain why patients participate in medical educational programs: retroactive emancipation. The program offered a way for patients' to counterbalance the dehumanizing care experience parts, give voice and drive for a change in how healthcare engages with patients. Conclusion: As patient engagement in medical education increases, we should consider how to make patient involvement more inclusive and authentic. By conceptualizing PAT programs as potential early stage emancipation movements we may better support educational program development that involves patients in a more humanistic and ethically sound manner to promote true patient-centered healthcare., Background/Purpose: Recently, patient engagement has shown promise in medical education including benefits in fostering non-clinical skills in students. However, how patient engagement promotes the development of such skills remain largely unexplored. This review aims to describe the characteristics and outcomes of interventions actively involving patients in medical education. Methods: A rapid review was conducted. We searched MEDLINE and ERIC for primary studies on active patient engagement in medical education, conducive to non-clinical skills. Two coders independently reviewed selected studies. A narrative synthesis focusing on interventions' characteristics and outcomes was performed. Towle's toponymy (categorizing levels of patient involvement) and Kirkpatrick's framework were used. Results: Our search yielded 2168 documents. 22 were retained after abstract and full-text screening. Described interventions involved encounter-based contacts (n=16) or more longitudinal initiatives (n=6). Patient's involvement in intervention's planning, if stated, was ranging from limited (n=3) to moderate or high (n=8). Patient's autonomy in interventions' implementation varied from quasi-total (n=2) to more limited with various levels of academic control. Studies reported outcomes related to students' reaction (n=19), changes in attitudes (n=17) and acquisition of new knowledge and skills (n=13). Conclusion: Few studies on patient engagement in medical education report acquisition of non-clinical skills. Most of those studies are quantitative, limiting our in-depth understanding of the mechanisms leading to skills development. More qualitative research is needed to explore learnings' “how's” and “why's” and to optimize patient's contribution to medical education., Background/Purpose: Although much has been written about the medical learning environment, the patient, who is the focus of our care, has been systematically excluded from this discourse. . The purpose of this study was to explore the role of the patient as an active participant with agency in an authentic medical learning environment from the standpoint of the learner, the faculty and most importantly the patient. We hoped to gain insight into the reinforcement of positive professional values such as patient-centred behaviours and a respectful environment. Methods: The study recruited attending physicians and medical trainees to adopt a “patient-centered clinic” approach where all case presentations were conducted in examination rooms with the patient, as opposed to a conference room. Using a design-based research methodology, semi-structured interviews explored the impact of the new learning environment. After each week of interviews, the study members discussed insights and the interview questions were refined. The preliminary sample included of the study with 5 attending physicians, 8 trainees, 5 patients and 1 family member. Results: Results revealed three themes: 1. The teaching model allowed for a more patient-centered and inclusive health care environment; 2. Attending physicians and medical trainees reported that presenting cases with the patient present challenged normal teaching practices and may have limited teaching opportunities; and 3. Although it was difficult to ascertain the effect on professionalism, patients felt more respected. This study provides a valuable platform for exploring the evolution of a positive learning environment with the lens of patient agency and centeredness., Background/Purpose: Students from lower socio-economic backgrounds who were state educated are underrepresented in medicine in the UK. Widening access to medical students from these 'non-traditional' backgrounds has become a key political and research priority. It is known that medical schools vary in the number of applicants from non-traditional backgrounds they attract and accept. This study seeks to explore how and why applicants from different social background choose which medical schools to apply to in the UK. Methods: We conducted a national qualitative interview study, adopting a critical realist perspective. We purposively sampled applicants and first year students from eight UK medical schools. Participants attended semi-structured individual or group interviews. We performed a framework analysis, identifying codes inductively from the data. Results: Sixty-six individuals participated; 35 applicants and 31 students. We identified three main themes: (i) priorities, (ii) perceived resources and constraints, (iii) strategies for choice. Participants' background influenced their priorities in selecting medical schools. Traditional applicants were more likely to prioritise prestige, whereas non-traditional applicants were more likely to describe being concerned with fitting in, being close to home, and finance. Some applicants had strong preferences for particular medical schools, whereas others were more concerned with simply getting in somewhere. Applicants described how their beliefs about their own educational, social, financial, and psychological capital expanded or constrained their choices. Conclusion: Priorities, and perceived resources and constraints shaped applicant choice of medical schools, and these varied depending on applicant social background., Background/Purpose: A key challenge for medical schools worldwide is identifying appropriate tools to select students ideally suited for medical practice from a competitive applicant pool. Situational Judgement Tests (SJT) are one such tool, designed as an ability measure of emotional management and predicting future professional behaviour. CASPer is a video-based online SJT developed by McMaster University and widely used in Canada. Our aim was to determine validity evidence for CASPer in an Australian medical student selection context. Methods: University of Wollongong (UOW) delivers a 4-year graduate medical program with a focus on medical care in rural areas. UOW MD selection algorithm includes scores from GPA, GAMSAT, extracurricular portfolio, rural background and MMI. In May 2018 UOW undertook a pilot administering an Australian specific CASPer test to MD applicants (n=1,548). Scores were correlated and disattenuated with other selection measures and demographics. Results: Significant correlation exists between CASPer and MMI (R=0.52,p, Background/Purpose: The University of British Columbia (UBC) is addressing the shortage of physicians in remote and rural communities in BC through a distributed model of undergraduate medical education (DME). For its Northern Medical Program (NMP), whose goal is to train physicians for northern and rural communities, a novel admissions tool, the Rural and Remote Suitability Score (RRSS) was developed. The RRSS was designed to provide an objective measure of undergraduate medical applicants' affinity for training in rural, remote, and/or northern settings and those most likely to practice family medicine in such communities. Methods: The RRSS is a self-report screening tool that is used as part of the admissions process to the NMP. The RRSS assesses students in four categories 1) Rural lived experiences, 2) Self-Reliance and Independence, 3) Rural related activities, and 4) other information including ties to rural areas and rural mentors. An adjusted total score RRSS is generated combining all categories. Practice locations were scored on a 6-point scale based on the BC Rural Subsidiary Agreement designation and population size. Practice locations were obtained from the College of Physicians of BC, the Canadian Medical Directory and alumni data. Results: Preliminary analyses of RRSS scores of graduating classes from 2008-2016 (n=245) indicated a significant positive correlation between RRSS adjusted total score and recruitment location r = 0.16, p < .05. Furthermore, it was found that 59% of the students who chose NMP as their first-choice ranking of the 4 DME sites of UBC pursued a career in Family Medicine. Conclusion: There is a positive relationship between the RRSS score and rural practice location. This supports the use of the RRSS as an admissions tool for rural DME. The results also demonstrate that students are more likely to pursue family medicine if they attend the Northern Medical Program, which was one of the purviews of the distributed site., Background/Purpose: Since the implementation of MMI in three French-speaking medical schools in Québec in 2009, higher scores are obtained by female candidates. Analysis of scores by gender and by age shows interesting patterns. The objective of this study was to study the effect of gender, age and their interaction in MMI scores. Methods: Scores on MMI from 2009 to 2019 were assembled. Raw scores from the sites were standardized on a common scale with a mean of 500 and a standard deviation of 50. Anova on mean scores and graphical presentations are used for analysis. Results: Results were obtained for 15,271 candidates. Mean score for women (n= 9,276) is 505.2 (sd = 47.3) and 491.2 (sd = 51.7) for men (n= 5,995). Significant effect of gender (F=97.51; p, Background/Purpose: Rural communities remain medically undeserved due to the maldistribution of health professionals. In Canada, 19% of the rural population is served by less than 8% of all physiotherapists. In an effort to increase recruitment and retention in rural locations, health profession education programs have made changes to selection processes and curricular experiences. However, evidence of their impact has been inconclusive. Methods: In response to the maldistribution problem, the Physical Therapy (PT) program at the University of British Columbia developed the “Northern and Rural Cohort”. Drawing on evidence that geographical background and exposure to rural practice settings influences practice location, its admissions process preferentially selected applicants with lived experience in a rural location and required students to complete four out of six clinical rotations in northern or rural communities. Chi-squared tests and binary logistic regressions were conducted using five years of data (375 students) to identify the impact of program changes on rural recruitment. Results: Post-graduation, significantly more PT students with a rural background (47%) are working in a rural community as compared with 8% from a non-rural background. PT students with a rural background were 9.5 times more likely to practice in a rural community (95% CI [5.1, 17.6]). The expanded rural clinical model was not as strongly associated with rural practice. Conclusion: This study found that targeted admissions criteria is needed to address maldistribution of physiotherapists. These results may inform other programs in developing strategies to increase recruitment of health professionals in rural communities., Background/Purpose: CASPer is a situational judgment test used for selection by many medical schools in North America. Associations between sociodemographic characteristics and scores were recently described in the USA. The goal of this study was to assess if subgroup performance differences were observable in a Canadian context. Methods: A sociodemographic questionnaire was distributed to applicants invited to at least one selection interview across 4 medical schools in Quebec in 2019. Data was anonymized and linked to CASPer z-scores. Mean comparisons between subgroups were made using Student's t-test and effect sizes were assessed using Cohen's d. A multiple regression model was then created using backward stepwise regression. Results: Sociodemographic data and CASPer results could be matched for 930 out of 1898 interviewees (49.0%). Their mean age was 21, 61.4% were women, 66.0% were white, 17.0% had a parental income Conclusion: On a subset of applicants invited to selection interviews in Quebec, CASPer scores presented subgroup differences related to older age and lower parental income. No subgroup difference between white and non-white applicants was observed., Background/Purpose: There is a deficit of empathy-based training and patient-experience education in the current medical education curriculum. This is in part due to a curricular focus on objective, scientific competencies rather than more subjective interpersonal skills. Medical education and training tends to focus on outcome-based thinking, but it is often unclear if the stated competencies observed in empathy and communication translate to real world ability. Summary of the Innovation: After interviewing groups of patients, an immersive 360 degree video simulation filmed from the perspective of the patient was created, meant to be viewed in a virtual reality (VR) headset. We showed the VR simulated patient experience to 12 medical students individually and then conducted three focus groups of four students each. The focus groups were recorded, transcribed and thematically analyzed to identify the major themes discussed. Five major themes were identified: 1) The 360-video format can serve as a stand-in for experiential learning 2) It was valuable to experience a care-provider's verbal/non-verbal communication from the patient's perspective 3) Self-reflection is important 4) There are several perceived barriers to empathy 5) Empathy being defined as something you think and act on, not something you feel. Conclusion: The patient's first-person perspective in a narrative vignette could enhance practitioners' reflection on patient experience and encourage a process-based thinking aligned with a person-centered care approach. The themes generated can help to inform how immersive simulations can be used in the medical curriculum to teach empathetic actions and the patient experience., Background/Purpose: Artificial Intelligence (AI) is rapidly transforming health care. Already, the U.S. Food and Drug Administration has cleared or approved health AI-based medical devices that can diagnose diabetic retinopathy, read scans for stroke, and detect wrist fractures. Despite its tremendous potential to transform health care for the better, AI also poses new ethical challenges for stakeholders, such as physicians, patients, and AI makers, that need to be addressed. For example, under what circumstances (if any) does a physician need to inform a patient about the AI used in their care? How does one deal with cases where the AI is a “black-box,” even for the physician? What sorts of biases might an AI perpetuate? We argue that medical schools should include a curriculum for health AI ethics. We have developed a case-based curriculum for health AI ethics for medical education that addresses these and other questions. Summary of the Innovation: In our presentation, we will give an overview of this curriculum and discuss examples for essential topics to discuss with the students such as issues of informed consent, bias and disparities, safety, transparency and trust, as well as data privacy. Conclusion: Currently, medical school curricula in Canada do not address such ethical issues. As future leaders of the health care system, medical students must be able to critically think about health AI and the ethical challenges associated with it. Not only will they likely have to practice medicine alongside health AI in the near future, but they will have a large role in shaping its implementation into health care., Background/Purpose: The way of the future requires significant opportunity to innovate in healthcare. Physicians are positioned to lead clinical innovation, given their firsthand exposure to healthcare challenges. However, they lack the necessary expertise in innovative methodology as there is no exposure to this in the Canadian medical education space. To fill this gap, we designed a seminar series in healthcare entrepreneurship for early stage medical learners at the University of Toronto; a first of its kind among Canadian medical schools. Summary of the Innovation: A series of semi-structured interviews were conducted with key stakeholders including physician entrepreneurs, local innovation leaders, curriculum specialists and medical students. Using thematic analysis, recommendations were extracted to inform the design of the program. The seminar series content was informed by a well-established entrepreneurial framework - MaRS Innovation Framework - and adapted to the needs of medical learners. The program consists of a 6-session seminar series outlining a methodological approach to the development of a medical startup. Each session is taught by an expert in the area, accompanied by student-led projects that promote the application of gained knowledge. Conclusion: Thematic analysis highlighted the following requirements: 1) thoughtful organization of the structure, content and delivery of seminars is key, 2) the program should serve as a catalyst for developing relationships between students and local entrepreneurial entities, and 3) the program should provide students with the opportunity to explore new career paths. The evaluation of this seminar series will inform future iterations with a goal to be a valuable platform for inspiring the next generation of healthcare entrepreneurs to transform the healthcare landscape., Background/Purpose: In the age of digital health care and emerging technologies, new models of virtual, online and digitally-enabled care are rapidly emerging. However, the impact of emerging technologies on the delivery of compassionate care is not well understood. There is lack of research around the impact of technology on the delivery of care and the capabilities required to deliver compassionate care in the digital ecosystem. Methods: To develop an understanding of the role of compassion in the context of digital health, an ecological approach was used to create a conceptual model of digital compassion. From the ecological perspective, a preliminary framework for understanding digital compassion was developed using a functional definition of compassion as the foundation. The preliminary framework was explored through two scoping reviews to further refine the model in the context of the research literature, as well as understand the use of digital compassion from the perspective of mental health care. Results: Based on a functional definition of compassion, a framework for digital compassion has been developed and includes six dimensions: 1) awareness of suffering; 2) digitally mediated responses; 3) online interventions; 4) digital training and coaching; 5) compassion oriented technologies; 6) compassionate oriented algorithms. This framework has guided two scoping review protocols. Reviewing 37 articles in mental health care, the predominant domains of research were online interventions, training and coaching and developing compassion-oriented technologies. Conclusion: A framework for digital compassion has been developed that can enhance our understanding of how to learn and teach the appropriate uses of digital tools to optimize care. The framework is currently being used to guide a modified Delphi process to identify capabilities and standards to advance digital compassion., Background/Purpose: We implemented self-explanation (SE) as a novel learning strategy in our UGME program knowing that SE increases diagnostic performance in clerks. However, we have yet to document what trainees do when asked to use SE outside of an experimental setting. Thus, we created, and proceeded to the validation of, a grid to document the quality of students' audio SE that was recorded when solving a clinical case. Methods: We proceeded to a validation approach informed by the Unified Theory of Validity. We documented evidences of content through the definition and operationalization of the construct of interest (SE). We documented evidences of internal structure using Intra-Class Correlations on 3 datasets (audio SE); and response processes using descriptive statistics. Results: We operationalized 3 indicators: clinical inferences (CI), biomedical inferences (BI) and monitoring (M). The team piloted and revised the grid through an iterative process until consensus about the grid's representativeness of the construct and its feasibility. The grid was applied by 2 team members to 30 SE, and yielded indicator ICCs of .81 (CI); .92 (BI); and .53 (M). After discussion, team members applied the grid to 2 other datasets (n=30 SE, and n=25 SE) and obtained ICCs of >.75. Mean CI varied from 16.27 to 27.04; Mean BI varied from 13.33 to 17.76 and Mean M varied from 2.03 to 3.10. Conclusion: We created a standardized grid to describe students' SE. The documented SE, as illustrated by mean CI, BI, and M, aligns with what we could expect from the students' level of knowledge. They followed instructions and made inferences that we would expect. We consider this to be an interesting tool to describe SE to eventually provide feedback to students and as data for research., Background/Purpose: Lifelong learning (LLL) is a driving force for continued professional development (CPD) in healthcare professions. Project Extension for Community Healthcare Outcomes (Project ECHO©) is a tele-education model designed to address and bridge knowledge gaps between academic specialists and healthcare providers in remote areas through the development of a virtual community of practice. While the use of the ECHO model is expanding rapidly, little is known about the relationship between LLL and ECHO engagement. The current project aims to assess how orientation to LLL changes with participation in a cycle of ECHO Ontario Mental Health (ECHO-ONMH). Methods: ECHO-ONMH completed Jefferson Scale of Lifelong Learning before and after each 36 week ECHO cycle to assess changes in orientation to LLL. A total of 41 providers were recruited over two consecutive ECHO cycles. We captured ECHO session attendance through a weekly registration database. Based on data distribution, participants were classified as high and low ECHO users using median session attendance (26 sessions) as a cut-point. Results: ECHO-ONMH participants' mean LLL scores were 44.56±5.48. Low ECHO-ONMH users (n= 19) showed no significant improvement in LLL scores pre- vs post-ECHO (p=0.54). However, high ECHO-ONMH users (n=22) demonstrated a significant improvement (Pre-ECHO:42.77±5.13; Post-ECHO:44.18±5.69, p, Background/Purpose: Ensuring curricular alignment of integrated vertical themes and program/course level objectives is essential. At the University of Saskatchewan, we have developed matrices to ensure program level objectives and integrated vertical themes are aligned with curricular outcomes. Methods: Gap reports are run in our data management system and matrices are developed to visually indicate where in our curriculum we are teaching our program level objectives and integrated theme objectives. The Program Level/Course level matrix identifies where course level objectives intersect with program level objectives. Likewise, the integrated theme matrix indicates where vertical themes intersect with course content. Results: The matrices offer a visual representation of the placement of our program level objectives and integrated vertical themes. They speak to the placement and adequacy of our curricular content and assist in adjudicating curricular change. At a glance, faculty and course reviewers are able to identify where program level objectives and integrated vertical themes are taught. Conclusions: The development and utilization of curricular alignment matrices has enabled us to identify, communicate, and review objective placement in our curriculum. While they are not the only way we monitor our curriculum, they assist in our curricular monitoring, review, and quality assurance process., Background/Purpose: As part of the accreditation process, medical schools are asked to show evidence of the effectiveness and value of their programs, a task that is assigned to the Office of Assessment and Evaluation. Medical schools collect a comprehensive amount of assessment and evaluation data from their students, however, to date, there is no overarching evaluation framework that allows us to use the collected data to create an accurate representation of the state of the medical program. Summary of the Innovation: The University of Toronto MD program, in preparation for its accreditation process in 2020 has developed a theory-informed evaluation framework that uses the MD program competency framework as a lens to analyze the assessment and evaluation data collected from students. This analysis allows us to determine how well the program is achieving the program goals. Specifically, the evaluation framework maps the assessment and evaluation data for each course (Pre-clerkship and Clerkship) to the MD program key competencies and using statistical analyses determines to what extent each course is achieving each of the key competencies. After implemented, courses receive a score for each of the key competencies. Conclusion: To our knowledge, this is the first program evaluation framework that uses assessment and evaluation data to determine the state of a Medical Program. Results can also inform the refinement of the program courses. The mapping process of assessment and evaluation data to the MD competencies is paramount to this framework. If completed correctly, other schools could implement this framework to analyze the state of their programs., Background/Purpose: Didactic lecturing is a demonstrably ineffective method for content delivery. Despite this, many medical schools still rely heavily on the lecture format due to a lack of obvious alternatives. Design thinking principles can be implemented to create such alternatives. The first stage of design thinking emphasizes data gathering, keeping users at the centre of the research, and engaging all stakeholders. The second stage consists of rigorous data analysis and the creation and evaluation of prototypes. The final stage assesses efficacy of the new systems as they are implemented. Summary of the Innovation: Between December 2017 and December 2018, we observed over 120 hours of student behaviours during lectures and small group sessions throughout the pre-clerkship. We also conducted 179 interviews and 9 focus groups with students, course chairs, faculty lecturers, technology management, and course administrators. 316 unique insights were identified and used to create twelve themes. Eighty-nine unique solutions were proposed by our team, which were bundled into twelve larger-scale solutions. We selected our top 5 “quick wins,” and top 3 “major projects.” Our Pre-Clerkship Committee has reviewed and vetted the innovations and provided good feedback for future directions. Conclusion: At this unique time in medical education, many programs are redefining themselves in order to determine the optimal method of content delivery. To our knowledge, we are the first program to use design thinking to create a student-centered approach to the delivery of course content. Our process uncovered rich data and insights that have previously gone uncaptured. The collection and application of this data is a critical next step towards a truly evidence-based medical education., Background/Purpose: Medical school curricula have high content loads with negative academic and personal consequences for medical students. From out of a vast amount of available information, curriculum designers need to select appropriate content. Establishing effective content rating criteria is vitally important yet it seems that there is little rationale for the terms and phrases used. This may lead to omitting important content and/or including unnecessary content. We explored the meaning and value of terms and phrases used to rate content when making curricular decisions. Methods: We designed a survey with all open-ended questions to ask participants in four stakeholder groups (education leaders, clinical faculty, basic science faculty, and learners) about what they thought selected terms and phrases meant and how suitable they thought they were for making content decisions. Results: Nineteen people representing all stakeholder groups completed the survey. We found an obvious lack of consensus surrounding the meaning and suitability of these terms. For instance, the 'general medical practice' was often confused with the 'family practice'. In addition, all stakeholder groups almost uniformly rejected the phrase 'needed for the minimally competent graduate'. The phrase 'to function safely in clerkship' was generally unacceptable to participants. Conclusion: We are concerned that faculty are making decisions about content without a common or clear understanding of terms and phrases used in the process. Our participants rejected two criteria but also did not generally endorse any of the others. Curriculum designers need to establish more consensus on the criteria used among faculty who choose content., Background/Purpose: In 2015, the UGME program at the University of Manitoba began implementing a renewed curriculum after a process that began in 2010. To identify factors that facilitate and impede the ongoing goals of curriculum renewal, we relied on Crossan's 4Is model of organizational learning that links individuals, groups, and the organization through the four processes of intuiting, interpreting, integrating, and institutionalizing. Methods: As part of a mixed-methods evaluation of the new curriculum, we conducted 16 individual semi-structured interviews with leadership, faculty members, and administrators who played key roles in the curriculum renewal process. We conducted an iterative thematic analysis of interviews informed by Crossan's 4Is model of organizational learning. Results: Analysis of interviews revealed that while many of the goals for the renewed curriculum have been achieved, some outstanding issues remain. Also, curriculum renewal is not a bounded event, but an ongoing process of organizational learning. The themes of Collaboration, Engagement, Leadership, Decision-making Practices, and Processes and Structures provide insight into the factors that facilitated and impeded the renewal process. Conclusion: Some of the goals of curriculum renewal have been achieved through strong leadership, frequent collaboration, and engagement from multiple stakeholders that facilitated the development of shared understandings through which new routines and processes formed. Curriculum renewal was impeded by inconsistent decision-making processes and evolving processes and structures in terms of manpower, recognition, and protected time. Findings provide insight into ways that outstanding issues can be addressed and that the on-going process of curriculum renewal can be supported through individual and collective actions., Background/Purpose: In response to higher rates of distress and burnout among medical students, the University of Toronto developed a 4-year integrative Resilience Curriculum (RC) that was embedded into the core Doctorate of Medicine curriculum. The RC consists of online modules, compulsory workshops, and video narratives that aim to equip students with tools to increase their resilience. Preliminary data captured students' perceived value of the RC. The goal of this study was to employ a theory-based evaluation to explore how the RC has unfolded to date, including its strengths and areas for improvement, from the perspective of its stakeholders: developers, defined as those who led the development of the RC, and implementers, defined as those who facilitated resilience workshops. Methods: Two focus groups, comprising of developers (n = 6) and implementers (n = 5), were facilitated. An iterative thematic content analysis was conducted. Line by line and axial coding were used for transcriptions. Codes were categorized to establish preliminary themes. Iterative discussions yielded final themes. Results: Both groups identified the integration of the RC into core curriculum and changes implemented as a response to student feedback as strengths of the curriculum. Limited training for implementers was identified as a shortcoming. Conclusion: Findings from this research can be considered when developing and implementing a medical education-based resilience curriculum. Themes emerged from this study may be used, in future, to inform the creation of an innovative tool that assesses the impact of RC on the resilience and well-being of medical students., Background/Purpose: “Surgery ABCs” is an educational healthcare podcast targeted at pre-school and elementary aged kids to provide basic information on the body and medicine. Podcasts are becoming increasingly popular as an educational tool for children. While many science-based podcasts are available for this age group, podcasts focused on healthcare are lacking. This gap provided a unique opportunity to create a podcast to empower kids to learn about their bodies, to prepare them for encounters with the healthcare system, and to encourage them to consider careers in healthcare. Summary of the Innovation: In association with the Surgery 101 project, we produced 11 “Surgery ABCs” episodes to address questions kids have about the body. Topics included: “What happens if I break a bone?” “Why does my stomach rumble?” “Where do farts come from?” “Why do my teeth fall out?” “Why is my pee yellow?” “Why am I ticklish?” “Why does food taste good?” “Why do I need to get my shots?” “Why does my heart beat?” “How can I blow out a birthday candle?” and “Why do I feel sad sometimes?” During each episode, the host, her daughter and a medical student discuss a part of the body, and highlight a practitioner that works on that area of the body in the 'Doctor of the Day' segment. The podcast is available on Spotify and iTunes, and has been downloaded more than 11,500 times; the episode on sadness has proven most popular among listeners. Conclusion: This project demonstrates that children and their parents are interested in learning more about the human body and that podcasts can be used to as an educational tool to address children's curiosity about their bodies, Background/Purpose: CaRMS data shows fluctuation in applications to general surgery. Our aim is to explore the current factors affecting medical students' perceptions of general surgery in order to guide curriculum changes and staff activities to promote student interest. Methods: This grounded theory qualitative research study used semi-structured, individual interviews. Ten medical students from all years of medical school at two institutions were interviewed to explore the appeals and deterrents of entering a career in general surgery and how these factors may affect their career choices. The interviews were recorded, transcribed, and underwent coding by two independent co-investigators for data analysis. Results: Students appreciated tangible outcomes, impactful work, and fast-paced workflow but struggled with rigorous training and the potential poor work-life balance in general surgery. Students expected egregious behaviours from residents and staff but reported mostly experiencing a willingness to teach, provision of clinical opportunities, and offers of research. If observed, students rationalized egregious behaviours to factors like fatigue and lack of agency. Institutional culture appeared to impact the experience of students on their surgical rotation. Conclusion: Work hours, tangible outcomes and fast-paced work define surgery. Early clinical exposure can help students understand these specialty-defining factors for career choice. Negative stereotypes about personality and culture still exist, but exposure to surgical ambassadors in early years can counteract the negative stereotypes at the outset. Facilitating positive surgical exposure can help students with making career choices., Background/Purpose: Development of expertise in complex skills, including surgery, requires deliberate practice. How practice is structured varies with diverse training requirements often leading residents to spend considerable time in non-operative rotations. Because advantages and disadvantages of such “gaps” are unknown, we examined longitudinal learning trajectories of residents and compared performance after prolonged periods of practice vs after gaps in training. Methods: Daily operative assessments were analyzed retrospectively with learning curves generated. To systematically assess the impact of gaps, we compared scores received by residents after two successive months in which they were not assessed operatively and two successive months in which they were assessed at least once. Results:4400 scores for 33 residents over a 10 year period were analyzed. Residents performed better during their third sequential month of being assessed (mean=4.40, 95%CI=4.33-4.46) relative to during months after being away from the operating room for at least two months (mean=4.21, 95%CI=4.13-4.29; p, Background/Purpose: Postgraduate training is transitioning to a competency-based model (CBME) with a focus on flexibility and high-value learning activities. The effects on workflow and resource requirements in academic centers is largely unknown. Accurate characterization of resident workload is essential to ensure successful implementation of CBME. Methods: A list encompassing the tasks performed by surgical residents on a daily basis was generated using expert consensus. Time-motion analysis methodology was used to revise the list and map tasks and time-on-task. Three trained observers tracked surgical residents throughout regular workdays and call nights. Multiple strategies were employed to reduce observer bias whenever possible. Results: Nineteen residents were observed for 631 hours over 50 work periods. 38 discrete tasks were identified, in 6 categories (direct patient care, indirect patient care, learning activities, transit, downtime and miscellaneous), each with an explicit definition. 99% of time was categorized using this system. The most common tasks were operating (134 hr), EMR interaction (68 hr) and patient assessment (61 hr). Only 38% of time was spent in direct patient care activities. There were differences in work patterns between residents' groups based on seniority level, service type (elective vs on-call), and time in academic year. Conclusion: This represents the most complete time-motion analysis study to date in surgical residents and provides key insights into their activities. Consideration should be given to developing strategies to increase time spent in direct patient care and critically analyzing the educational value of indirect care tasks. Additional resources should be allocated for the transitions in resident workload mandated by CBME., Background/Purpose: General surgery resident attrition highlights a need to support well-informed specialty selection. This study evaluated the role of overnight call shifts in surgical career exploration for pre-clerkship medical students. Methods: The mixed-methods design utilized entry and post-call shift surveys and focus groups. Survey data characterized the population and call shift, guided focus group segmentation by baseline interest in surgery, and provided context to interpret qualitative data. Focus groups were transcribed and analyzed with a phenomenological approach using thematic analysis. Results: Twenty-five first-year medical students participated in a call shift at two level 1 trauma centres. Sixty-four percent (n=16) of participants were male. The high interest group (n=9) had more prior operating room exposure than the moderate (n=12) and low (n=4) interest groups (p=0.039). Most students valued participating in a call shift; 80% (n=20) rated the experience “positive” or “very positive.” Thematic analysis yielded two categories of themes: 1) Valuable aspects of the experience, including being part of a team, mentorship, understanding the clerk's role, dispelling misconceptions, trial of working overnight, and influencing interest in a surgical career; and 2) Determinants of an enjoyable experience, including resident engagement and number of traumas. An overnight call shift experience was valuable regardless of students' baseline interest in surgery. While it only influenced a few students' specialty preferences, exposure facilitated a better understanding of a unique component of surgical careers and provided valuable mentorship. Summary: Twenty-five first-year medical students participated in a call shift at two level 1 trauma centres. Sixty-four percent (n=16) of participants were male. The high interest group (n=9) had more prior operating room exposure than the moderate (n=12) and low (n=4) interest groups (p=0.039). Most students valued participating in a call shift; 80% (n=20) rated the experience “positive” or “very positive.” Thematic analysis yielded two categories of themes: 1) Valuable aspects of the experience, including being part of a team, mentorship, understanding the clerk's role, dispelling misconceptions, trial of working overnight, and influencing interest in a surgical career; and 2) Determinants of an enjoyable experience, including resident engagement and number of traumas. An overnight call shift experience was valuable regardless of students' baseline interest in surgery. While it only influenced a few students' specialty preferences, exposure facilitated a better understanding of a unique component of surgical careers and provided valuable mentorship. Conclusion: These findings support implementing call shift experiences in curricular or extracurricular programs to increase accessibility and enable earlier, informed career decision-making., Background/Purpose: As we transition to Competency-Based Medical Education, the increased demand for workplace-based assessments (WBA) leads to new challenges for implementing suitable WBA tools with published validity evidence, while also being feasible and useful. Despite published evidence to support their validity, there has been very poor uptake of WBA tools in ophthalmology residency programs in Canada. In order to understand why evidence-based assessment tools may not be incorporated into residency programs, it is necessary to understand the perspectives of stakeholders who are ultimately the end-users of these tools. Methods: We investigated WBA implementation by studying their feasibility. Eleven surgical teachers used 3 daily assessment tools while supervising cataract surgery with ophthalmology residents. Semi-structured interviews with teachers and a focus group with the residents enabled discussion of feasibility. Interpretive description, a qualitative methodology, was used to guide data analysis. Results: Three themes emerged: (1) Surgical teachers' primary goal for assessment is to provide feedback to improve surgical competence. (2) Surgical teachers preferred the assessment tool with a design that best aligned with their approach to teaching and how they wanted to provide feedback. (3) Orientation to the tools, combined with established remediation pathways, may help preceptors to better use assessment tools and improve their ability to give critical feedback. Conclusion: Feasibility of a WBA tool may be based primarily on its perceived educational impact. Tools that emphasize feedback and align with teaching practices may improve feasibility to stakeholders and help to overcome known threats to feasibility such as long tools and frequent submissions., Background/Purpose: Training future physicians to provide compassionate, equitable, person-centred care remains a challenge for medical educators. Dialogues offer an opportunity to extend person-centred education into the real-time, situated contexts of clinical care. In contrast to discussions, dialogues encourage the sharing of authority, expertise, and perspectives to promote new ways seeing. Yet how to best implement dialogic teaching in graduate medical education is unknown. Summary of the Innovation: The core project team and a pilot working group (PWG) of physician-teachers co-constructed and implemented a faculty development program and dialogic education model to promote dialogic teaching in clinical settings. The team kept detailed implementation notes and interviewed PWG members. Data was co-analyzed using a qualitative description approach within a constructivist paradigm. Ongoing analysis informed iterative changes to the faculty development program and dialogic education model. Patient and learner advisors were engaged to gain practical guidance. Conclusion: The concepts and practice of dialogic teaching resonated with PWG members. The group found that the dialogic structure of faculty development meetings and the legitimacy afforded by a formal label for the approach enabled dialogic teaching. In contrast, PWG members cited insufficient time, lack of space, and other structural issues as barriers. Patient and learner advisors provided important insights to deepen the design, implementation, and eventual evaluation of the dialogic education model. While our dialogic teaching approach is intended to be transferrable beyond our Department, successfully enabling this approach requires expertise, willingness, and support to teach knowledge and skills not traditionally included in medical curricula., Background/Purpose: Incoming medical residents transition from being learners to both learners and teachers over a short time. This period is marked by increased responsibilities and provides an opportunity for reflection on their own educational experience and their perception of the teaching role. Early experiences impact the enactment of their role as teacher and the development of their identity and could be harnessed to inform further training. Summary of the Innovation: To equip incoming residents with an understanding of their teaching role and basic clinical teaching skills, the Office of Faculty Development has developed a mandatory online module which all incoming residents complete within six weeks of entry. This module forms the introduction to a longitudinal Resident as Teacher (RaT) program. Embedded within the module are refective exercises about the qualities of memorable resident teachers and questions about their expectations of their teaching role. Since 2017, 1200 complete data sets have been collected and analyzed for emergent themes. Conclusion: The emergent themes are: 1) The top memorable qualities of resident teachers are being approachable, enthusiastic, and consistent, and these were some of the qualities they sought to emulate while they themselves began to teach; 2) 'Pimping', 'being crabby' and making the student feel stupid were the poor qualities they had experienced; 3) Residents felt that teaching would solidify their own knowledge but that they would be challenged by time constraints, lack of experience and not knowing how to address different levels of learners. These themes inform Residency Program Directors as they plan teaching opportunities and training for residents, and also inform the continuous development of the RaT program., Background/Purpose: Point of Care Ultrasound (POCUS) has changed the face of acute care medicine, and has numerous life- and cost-saving applications. POCUS is provided by not only physicians, but also by residents and, increasingly, medical students, as an adjunct to the physical examination and to expedite the provision of safe medical care. Nationwide expert consensus has established that core POCUS techniques are appropriate for undergraduate medical school training, however due to time and training constraints, medical schools have made limited strides in training medical students in POCUS either prior to or during clerkship. One of the most significant limitation to POCUS training is insufficient time for educators to provide hands-on training sessions. However, many existing peer-teaching modules exist, and medical students provide peer teaching in topics such as anatomy, at multiple medical schools, with good success. Similar peer-teaching curricula, designed according to accepted nationwide consensus and disseminated by the students themselves, could become perfect efficient vehicles for providing POCUS training among medical students, in a timely and cost-effective manner. Summary of the Innovation: We developed a peer-teaching curriculum specific to the training needs of pre-clerkship medical students. The curriculum uses a graduated model of POCUS skill development, and includes competency checklists established by a panel of physician experts across clerkship disciplines. We pilot tested the curriculum at a two day workshop for clerkship medical students organized by students interested in training not yet offered at their medical school site. Students enrolled in the workshop used the curriculum to teach each other each POCUS techniques, and were assessed at the end of the workshop on their knowledge and scanning competencies by faculty trained in education and assessment of POCUS. Conclusion: Medical students can be effective peer-teachers of POCUS skills for pre-clerkship and clerkship level applications. Using peer-teaching curricula could be a means to offload instructor demands and permit more rapid and sustainable dissemination of foundation POCUS skills across undergraduate medical students nationwide., Background/Purpose: Understanding the impact of policy on health, physicians are advocates for both individual patients but the communities they serve. It is challenging to effectively teach medical students advocacy through didactic lectures. Experiential learning is an increasingly utilized pedagogical tool to teach skills that are difficult to acquire in the classroom. We set out to determine whether experiential learning is an effective strategy in teaching advocacy skills for medical students. Methods: We conducted a mixed-methods study of medical students participating in the 2019 CFMS Day of Action, where students met with policymakers in Ottawa to advocate for healthcare policy change. Participants completed a modified Social Issues Advocacy Scale questionnaire prior and following Day of Action. A select number of participants also participated in semi-structured interviews, which were transcribed and analyzed using a grounded theory approach. Results: Questionnaires were completed by 33/68 students (48.5%) prior to Day of Action and 27/68 (39.7%) following. Overall, participants scored 78.5 (out of 100) on the scale prior to Day of Action participation and 87.0 following (p = 0.0035), indicating increased political awareness and confidence in advocacy skills. This was confirmed in our analysis of individual student interview transcripts, where themes of increased understanding of political advocacy along with improved competence and confidence in advocacy skills were identified. Conclusion: Our results support the notion that experiential learning can be an effective means of teaching advocacy skills for medical students. Medical educators teaching advocacy should consider experiential learning as a supplement or alternative to in-classroom approaches for health advocacy training., Background/Purpose: While research has studied formal clinical documentation practices, less is known about clinicians' creation and use of informal documents in care practices. Trainees often create their own personal documentation systems, frequently through trial and error. In this study, we set out to explore the significance of clinicians' personal notes for clinical care, professional training, and research. Methods: Across 8 of our prior studies, clinicians' personal notes were identified as important tools of clinical practice. Bringing these informal documents together into a single data set, we studied the use of personal notes across several clinical contexts. We engaged in a rhetorical analysis of these notes to explore how they are used in clinical contexts. Results: We consistently noted the use of personal notes to support patient care. Experienced clinicians had well established highly structured and well-established practice; trainees and newer to practice clinicians were continually developing personal documentation strategies. Rarely were novices explicitly taught personal notes strategies. Four overarching purposes of personal notes were identified: 1) Cognitive tool for bundling patient information; 2) Temporal boundary object for supporting personal remembering over a hospital stay; 3) Collaborative tool for supporting handover and other shared care tasks; and 4) Structuring tool for organizing daily tasks. Conclusion: Personal notes are integral to safe and effective clinical practice. Despite their ubiquitous nature, personal notes have been largely ignored in research and teaching. The types and uses of personal notes should be explicitly studied and taught so as to maximize their benefit to learning and to practice., Background/Purpose: Public medical education programs (e.g., Mini Med Schools (MMS)), frequently limit evaluations to self-reported learner satisfaction. Based on Kirkpatrick's evaluation model, other methods could be used to assess educational impact. Instruments such as retrospective pre/post surveys (RPPS) detect a shift in learners' understanding, while script concordance tests (SCTs) measure clinical reasoning. Unaware of any publications about knowledge increase, application, or retention in MMS participants, we wondered whether RPPS and SCTs be used to evaluate such programs? Methods: A 6-week MMS for the general public consisting of weekly 2-hour lectures on basic sciences and biomedical topics was delivered by medical faculty, covering material similar to medical school lectures. RPPS and SCTs were administered to all participants at the end of each lecture with SCTs repeated 8 weeks post-MMS. Results:59 participants(, Background/Purpose: Every medical school integrates library-based instruction in finding and evaluating evidence as part of its core curriculum. By the beginning of Year 3, undergraduate medical students have consolidated their preferred search methods and are given a refresher assignment to ensure that they are using the breadth of resources available. Historically, the results of this assignment demonstrated students' skill in finding evidence, but did not elucidate knowledge gaps, frustrations and barriers to their identification and use of evidence. We describe a simple education innovation of reorienting an assignment to build student self-awareness about searching for evidence. Summary of the Innovation: We embedded a reflective component into an existing assignment without lengthening it. We asked students to compare multiple resources and to reflect on a challenge they experienced when searching for evidence to complete the assignment, or on a strategy they used. Responses were analysed and themes identified. Conclusion: Major themes included: inability to find an article specific to every component of their question; difficulty narrowing search results; and successful use of rediscovered tools and strategies. Reorienting the assignment helped students to demonstrate self-awareness about their uncertainty and knowledge gaps in searching for evidence, and to celebrate their successes with new skills and tools for effective searching. Knowing what makes students feel frustrated, uncertain, or confident about searching, helps librarians tailor future instruction to students' articulated learning needs., Background/Purpose: Exposure to and participation in research activities have widely been reported as methods to engage undergraduate students in the life sciences and medicine in the principles of epidemiology, research methods and applied statistics. Despite this awareness, there is a lack of experiential learning opportunities in clinical research which focus primarily on developing these skill sets and applying them to medical research in a specific discipline. Summary of the Innovation: The Multi-Organ Transplant Student Research Program (MOTSRTP) was introduced at Toronto General Hospital, University Health Network in 2009, to provide post-secondary and medical students the chance to gain exposure in healthcare and research. Students attend educational seminars and clinical observerships; as well as undertake clinical research duties in order to gain insight within transplantation. Through a 53-question survey, we investigated feedback from past MOTSRTP participants and evaluated the impacts the program has had on their academic and professional goals. Conclusion: To date, 277 students have been trainees in the MOTSRTP. We achieved a response rate of 35.7%. Respondents spent an average time of 20 months in the program. Common motivations to join the MOTSRTP were to gain experience in research, work closely with individuals in the healthcare field, and gain knowledge in transplantation. 71.9% of respondents strongly agreed that the MOTSRTP improved skills that benefited their future educational/career pursuits. Trainees rated the program positively, in terms of skill development, educational, and clinical opportunities. During and after participation in the MOTSRTP, trainees have published a total of 174 abstracts and 92 peer-reviewed papers; presented at 226 conferences; and received over 60 research grants. Trainees suggested improvement in the areas of training in statistics and student leadership opportunities. The impact of the MOTSRTP on trainees' pursuit of transplantation-related careers and/or transplant advocacy warrants further study., Background/Purpose: Health care usage and costs are constantly under scrutiny. Campaigns targeting these issues mainly address over utilization which increases resource strain; however under-utilization may result in inappropriate patient care. The Best Practices in Medicine (BPiM) project combines a personalized audit and feedback framework with online reflective activities with the aim of right-sizing utilization. Summary of the Innovation: Institutional data was used to develop personalized score cards for each physician. Personal results were presented beside overall division and department results as comparisons. On line guideline and education activities were provided for individual interaction. Conclusion: Implementation of the BPiM Project led to a reduction of resource utilization and an increase in requests for resource utilization for abnormal results. Additionally, the introduction of scorecards led to discussions between colleagues and creation of 'informal' communities of practice (COP). These discussions and COPs led to further exploration of practice patterns and future initiatives to manage resource utilization., Background/Purpose: Research shows that physicians and teams lack the knowledge and confidence to effectively address weight concerns with patients. There is emerging research demonstrating the positive impact of collaborative, whole-person approaches to clinical communication about weight and health. Yet, there is a pressing need to translate evidence and innovative approaches into high quality training programs in obesity prevention and management. The 5As Team developed and evaluated a workshop for multidisciplinary learners based in principles of experiential learning. The workshop takes the learners outside of the classroom and engages them in activities to foster reflection about obesity discourse, to question assumptions, and promote understanding of what it is like to live with obesity. Summary of the Innovation: The workshop emphasizes experiential learning and incorporates didactic lectures. Learners have the opportunity to wear a bariatric suit, simulating the encumbrance of a larger body. In addition, learners explore a therapeutic approach that transforms clinical conversations into collaborative deliberation about improving health within the specific life context of the individual patient, and practice the approach with tools that guide the conversation. Conclusion: Evaluations of the workshop highlight experiential learning elements of the program as being crucial to increasing confidence when engaging in weight-related conversations with patients. Learners expressed interest in implementing a collaborative, whole-person approach and tools in their own practice. Experiential learning offers an innovative approach to obesity prevention and management training that stretches beyond the biomedical realm and introduces the human complexity and contextuality of living with obesity., Background/Purpose: Faculty development is increasingly important in health professions education. Faculty developments' conceptualization has evolved from an individual skills training activity to more contemporary notions of an organizational model. This organizational model recognizes relationships and networks as increasingly important mediators of knowledge mobilization. Although these conceptual advancements are critical, we lack empirical evidence and therefore robust insights into how networks shape processes of learning in faculty development. To fill this gap the following research question was explored: How do the professional social networks of faculty shape their learning about teaching? Methods: This study used a qualitative social network approach to explore how teaching faculty's relationships influenced their learning about teaching. The study was conducted in an undergraduate course at a Canadian medical school. Eleven faculty participants were recruited and 3 methods of data collection were employed; semi-structured interviews, participant drawn sociograms, and demographic questionnaires. Results: Results showed that the networks of faculty participants influenced their learning about teaching in the following four areas: knowledge acquisition and mobilization, identity formation, vulnerable expression (intellectual candour), and scaffolding. Conclusion: Our insights illuminate how social factors may influence faculty's learning about teaching. The findings support the recent calls to re-orient faculty development in the health professions as a dynamic social enterprise. We propose that faculty developers should consider faculty's social embeddedness in their professional social networks to strategically enhance and optimize faculty learning., Background/Purpose: Instruction that encourages trainees to integrate conceptual “why” and procedural “how” knowledge improves their transfer of procedural skills. Questions remain, however, for how to represent the causal relationship between clinical concepts and procedural actions (e.g., how anatomy relates to needle insertion). We compared video-based and simulator-based approaches for presenting these causal relationships during simulation-based lumbar puncture (LP) training, and measured impacts on participants' retention and transfer. Methods: During a 1-hour session, we randomized 66 medical students to one of three instructional interventions: i) video-based procedural-only instruction, ii) integrated video-based instruction, and iii) integrated simulator-based instruction. One-week later, we tested participants' LP skill retention and transfer, and their conceptual and procedural knowledge on a written test. Results: Simple mediation regression analyses revealed that participants receiving integrated instruction had superior LP retention and transfer outcomes, mediated by gains in conceptual knowledge (all p0.01). Participants receiving procedural-only instruction practiced significantly more LPs during training (M=2.36) than participants receiving integrated video-based (M=1.82) and simulator-based instruction (M=1.50), p, Background/Purpose: MCC 360 is a unique multi-source feedback (MSF) national program designed to support physician QI around the CanMEDS roles of collaborator, communicator, and professional. Quantitative ratings and qualitative comments are collected from a sample of physician colleagues (PC), co-workers (C), and patients (PT). These data are supplemented with self-ratings and reported back to physicians. Each physician reviews the report with a trained feedback facilitator and creates an action plan for QI. This study explores how four MSF elements (survey items, comments, facilitation, and action plans) support the elicitation and translation of feedback into a QI plan for change. Method: Data included survey items, rater comments, facilitator reports, and action plans for 174 physicians. Word frequency queries and thematic analysis were used to identify common words and concepts and explore relationships among data sources. Results: Overlap between high frequency words in surveys and comments was substantial (61% for PC, 55% for C, and 65% for PT). The language used to describe goals in physician action plans was highly related to respondent comments (53% for PC, 52% for C, and 45% for PT) but not to survey items (18% for PC, 18% for C, and 15 % for PT). Themes in facilitator reports relate to action plan content (72%). Conclusion: Each MSF element investigated plays a role in eliciting and translating feedback into action. Rated survey items prime respondent comments. Comments contextualize feedback messages. Facilitation supports interpretation and reflection. Action planning translates feedback into a structure to support change., Background/Purpose: Program directors (PDs) have complex roles in residency education and are expected to demonstrate competence in multiple areas specifically, leadership. However, PDs can receive minimal to no feedback on their leadership performance. McGill University's Postgraduate Education team aimed to develop a program evaluation process using a multisource feedback (MSF) form to provide feedback from multiple perspectives within the residency program to PDs. Summary of the Innovation: The MSF form was developed using an iterative and scholarly approach, including a literature review to identify PD competencies, identification of PD roles from the PGME job description and mapping to the CanRAC Standards. Prior to implementation, the form was pilot tested with 5 residency programs ensuring applicability, relevance, and value of the MSF form items. Feedback was incorporated into the final version of the form. The MSF form was distributed to the Department Chair, PD, Program Administrator, Faculty Member, and Chief/Senior Resident(s) to gather standardized performance data of a residency program PD who completed 12-24 months of service. Data were analyzed to provide an aggregate score for the PD's performance. Scores were matched to an analytical rubric allowing the PGME Office to provide a one-page report with formative feedback and strategies to enhance PD performance. Conclusion: The MSF form establishes a formal and standardized QI process to provide PDs with formative feedback on their competencies that can potentially enhance performance. The form will undergo a meta-evaluation at year 1, 3 and 5. Additionally, the form provides an opportunity to highlight the performance of PDs with effective leadership and informs the PGME Leadership and Department Chairs of competencies that result in effective leadership of residency programs., Background/Purpose: Residency training takes place in a work-place learning environment. Each supervisor may have a different approach to the delivery of their feedback and may deliver different assessments for the same quality of performance. Research question: among residents who receive regular feedback how do different styles of feedback by supervisors impact the residents' learning? Methods: A qualitative methodology was used. Participants were residents from residency programs that have routine one-on-one feedback and assessment. In depth, semi-structured one-on-one interviews were conducted by the primary investigator (PI). These were then transcribed, reviewed and coded. The participants were University of Toronto and McMaster University residents. Sample size was determined by thematic saturation. The interview guide was updated in an iterative fashion to further explore themes generated in the initial interviews. Interview transcripts were reviewed and coded by the PI with assistance from collaborators. Results: Analysis of the eighteen participants revealed five themes. Residents employ reflection to consolidate the feedback they receive; the source of the feedback matters: both relationship with the resident and their credibility; emotional responses impact how feedback is interpreted; the content of the feedback remains important; and, residents actively reconcile feedback that is incongruent with previously received feedback and their own self-perception. Conclusion: How residents use feedback to further their learning is variable. The individuality of these responses to feedback are important for trainee self-reflection in furthering their learning as well as important in faculty development as they develop skills in assessment and feedback., Background/Purpose: Competency-based medical education (CBME) requires increased feedback based on direct observation, but this can be challenging for rare events such as resuscitation cases. Simulation provides an environment where such rare events can be practiced and observed. Further, with the implementation of CBME there is a renewed interest in multi-source feedback. This qualitative study explored the focus and effectiveness of multi-source feedback provided by multiple stakeholders in a simulation-based resuscitation course. Methods: The course consisted of 12 resuscitation cases and was completed by 87 first year residents from 14 specialties at two Canadian institutions. Faculty, co-residents, and a nurse completed narrative assessments after each case. Self-assessments from each resident were also collected. All comments were analyzed using an emergent thematic approach using NVivo. Results: Four themes emerged from the data: Communication, Leadership, Confidence and Comfort, and Medical Expert. Faculty focused their feedback on the Medical Expert theme, commenting on topics such as therapeutic and diagnostic actions. Registered nurses focused most of their feedback on the Communication theme, not only with the patient and their family, but also within the resuscitation team. Resident peers mostly provided feedback relating to the Leadership, Confidence and Comfort, and Communication themes. Residents focused their self-feedback on the Confidence and Comfort theme, anticipating the extent to which they could manage the scenario. Conclusion: These findings demonstrate the importance of involving multiple stakeholders in providing feedback to residents. The inclusion of multiple stakeholders helps to provide residents with holistic feedback spanning across multiple areas of their performance., Background/Purpose: Workplace-based assessment of competencies may be further optimized by drawing upon the impressions of multiple assessors, including those outside the trainee's discipline. Feedback related to interprofessional roles like communication and collaboration are often considered suitable for credible team input. However, we actually know very little about how clinicians across professional contexts judge these competencies for trainees outside their discipline. Methods: We adopted a constructivist grounded theory approach to explore perspectives through semi-structured interviews with multidisciplinary team members on a clinical training unit. A purposeful sample of dietitians, nurses, therapists, pharmacists, physicians, and social worker participants were asked to describe expected communication and collaboration performance of their own students as well as from trainees outside their profession joining the team. They were also asked to share their views on multisource feedback (MSF) in their setting Conclusion: Team members often grouped communication and collaboration roles for trainees outside their profession, especially as it pertained to patient encounters. Expectations were consistent (e.g. be kind, minimize jargon), but the utility of offering such vague feedback was questioned. Conversely, how trainee's from other professions shared patient information to inform their own care was concrete. Participants formed favourable impressions of students who are accessible for consultation, proactively seek and offer data for decision-making, respond to questions in a timely manner, and are respectful. These team members had occasionally solicited MSF but many were reluctant to offer input about trainees from other professions without repeated opportunity for observation. Conclusion: Our findings suggest there may indeed be distinctions between expectations of how mixed-discipline trainees should communicate and collaborate among interprofessional team members. However, not all clinicians believe their input on other students' performance is necessarily legitimate given brief or infrequent encounters., Background/Purpose: Research identifies the critical role that facilitation plays in promoting reflection and supporting performance change following multisource feedback (MSF). The R2C2 model was developed for initiating feedback conversations using data to plan and implement practice change. This study investigates how physicians who underwent MSF, followed by a conversation with an R2C2-trained facilitator, reacted to their feedback; and which CanMEDs roles were targeted in the development of action plans. MethodsFor this study, 139 Alberta physicians underwent MSF followed by a one-hour conversation with a trained facilitator to review the MSF data and discuss action plans. Following the conversation, each physician created up to three action plans. For each session, facilitators wrote a report describing their interaction with the physician, including a section on how the physician reacted initially to their MSF data. Participant data and facilitator reports were used to code physicians' reactions as either receptive or non-receptive. In addition, observable change targeted in physician action plans was coded against the CanMEDS framework. Results: The majority of physicians (96%) were receptive to their MSF data. Regardless of reaction, most action plans targeted the Communicator (40%), Collaborator (15%) and Professional (15%) CanMEDs roles. Less receptive physicians were more likely to target changes related to the Professional role (25%), and less likely to target changes related to the Collaborator role (4%) compared to those who were more receptive (15% and 16%, respectively). Conclusion: There appears to a relationship between physician reactions to MSF, receptivity, and targeted roles in developed action plans., Background/Purpose: Academia benefits family medicine clinical practice through better research, teaching, and scholarship. However, the status of academic departments of family medicine is still unequal. Academic family physicians may therefore be motivated to project onto others an enhanced representation of themselves as a professional group (image) with the aim to improve the perception others hold about them (reputation), as well as their own sense of self (identity). The research question was: Why are academic family physicians motivated to control/improve their professional image in academic contexts? Methods: This was a case study conducted in medical schools from Canada, France, Ireland, and Spain. Participants per case were 10-15 family physicians holding an academic appointment (n = 53). Data sources included individual semi-structured interviews and organizational documents. Rhetorical analysis was applied to interview transcripts. Results: Participants offered arguments of different order (pathos, ethos, logos) to construct a positive image of family medicine as academic discipline. Emotional appeals included 'professional pride' and 'personal preference for long-term doctor-relationships'. Ethical arguments comprised 'the role of family medicine in ensuring quality of care', and the need to 'respect the professional expertise' of family physicians. Logical appeals concerned the 'current momentum of family medicine', its 'importance for the healthcare system', and the 'valued role of family physicians in teaching in the community'. Conclusion: International family physicians appeared highly motivated to improve their professional image in academic centers, not only for personal reasons, but also for ethical and logical concerns grounded in their sense of accountability in healthcare delivery., Background/Purpose: Choosing a medical career path is complex and anxiety producing for students. Many have a perception that they must commit to a medical career choice early in order to be competitive. Prior experiences influence a priori attitudes towards careers and, particularly in a 3-year curriculum, may also shape the final choice. Objective: to identify variables associated with initial choice of discipline. Methods: First year medical students in 2 consecutive classes completed an anonymous online survey in orientation week. Results:81.4% and 90% classes 2021 and 2022 respectively. Mean age and gender did not differ between the cohorts. 26% (both cohorts) had already decided on a career path and, in most cases, this choice was based upon personal or professional experiences prior to entering medical school. In both cohorts, variance in the initial choice of discipline (Emergency Medicine the most popular, Anesthesia and Psychiatry the least) was largely explained by whether students felt confident describing the day-to-day activities of this type of physician. The criteria being used to select a career showed no gender differences, but a consistent finding in both cohorts was that females were more likely to consider OBGYN (odds ratio (OR) 6.7 - 10.7) or pediatrics (OR 3.7 - 4.7) and less likely to consider surgery (OR 0.1 - 0.3) as a career choice at the time of entry into medical school. Although the majority of medical students have not chosen a medical discipline at the time of entry into medical school, there are large differences in the likelihood of a discipline being an initial choice. Our data find that students' gender and familiarity with a discipline associate with initial choices., Background/Purpose: Clinical teachers must perform tasks involving both education and patient care. However, little is known about how they manage and make sense of their professional identities (PIs). The present research examined the lived experiences of teachers in family medicine as they negotiate their PIs during a faculty development program (FDP). Methods: This study adopted interpretative phenomenological analysis; a methodology that explores in-depth how people conceptualize their world while adopting an insider's perspective. Six teachers in family medicine participating in an international blended education FDP were purposively sampled. In-depth semi-structured individual interviews were conducted and thematically analyzed. Six identity diagrams were then created with the aid of the emergent themes to depict the relationship between the identities that each participant had identified. Results: Although participants had a unique lived experience and career path, all identity diagrams reflected that participants recognized one identity (i.e., embedding identity) containing other roles akin to their professional world. This identity dynamic allowed them to meaningfully reconcile the different demands and beliefs from their multiple and overlapping PIs. Such a sense-making process enabled them to work in complex contexts and assume multiple responsibilities that involved patient care, teaching and learning. Conclusion: The empirically grounded notion of embedding identity is a strategy to make sense of many PIs. An embedding identity embraces others, without necessarily creating a hierarchy, and thus makes possible certain meaning, unity and harmony. FDPs could help clinical teachers to identify an embedding identity to support them in meeting the overlapping demands in education and patient care., Background/Purpose: Le campus de l'université de Montréal en Mauricie existe depuis 2004. En plus de leur rôle de clinicien , les médecins ont dû développer une pratique d'enseignement. Des besoins de formation en pédagogie ont émergé . Pour développer cette nouvelle culture et cette nouvelle identité professionnelle d'enseignant, une formation adaptée a été créée. Summary of the Innovation: Un programme de 5 jours sur une année est offert aux cliniciens médecins de famille et spécialistes. Un animateur -formateur accompagne les participants ( 10 à 12 ) à travers divers thèmes comme : la position d'apprentissage, les stratégies d'enseignement, la rétroaction, la prescription pédagogique, le curriculum caché, la motivation, le raisonnement clinique, l'étudiant en difficulté, l'identité professionnelle … Chacun est abordé en lien avec les différents rôles du clinicien-enseignant . L'identité professionnelle de l'enseignant se forme dans ce parcours en favorisant l'apprentissage par l'interaction entre les participants, les travaux, lectures et les journaux réflexifs. Les participants sont encouragés à réfléchir seul et en groupe sur leurs valeurs personnelles, professionnelles et sur leur enseignement. Ces réflexions permettent d'actualiser ou de modifier leur pratique d'enseignement Conclusion: Depuis l'instauration du programme , 5 cohortes ont suivi le programme ( 56 participants) À terme , les participants ont exprimé mieux percevoir leur rôle de clinicien enseignant , être plus motivé à enseigner et mieux outillé. Ils deviennent des agents multiplicateurs auprès de leur pairs au profit des étudiants., Background/Purpose: For more than twenty years, the Canadian Medical Association (CMA) has given first year medical students across Canada a knapsack, co-sponsored by their provincial medical association and (in previous years) by MD Financial Management. “The backpack” is ubiquitous in hospitals and on medical campuses and has become a pan-Canadian symbol of medical learners, the cornerstone of a hashtagged marketing campaign, and part of a much anticipated rite of passage for new students. The semiotic meaning of '#myCMAbackpack' in medical education, however, remains undertheorized. Methods: The CMA backpack was examined as a socio-material artefact of contemporary Canadian undergraduate medical education (UGME), replete with its own agentic effects. Data was collected iteratively in response to themes identified through constant comparative analysis using NVivo 12. Materials for analysis included autoethnographic field notes, Twitter posts in the public domain using the hashtag “myCMAbackpack”, online publicity materials related to the backpack, and five backpacks distributed to Canadian medical students between 2013-2019. Results: Using actor-network theory as a touchstone, twin themes of initiation and identification developed as important in understanding symbolic meaning(s) of the backpack in UGME. For professional associations, events where the backpacks are revealed and distributed act as a form of initiation: representatives of the Canadian medical associations welcome students into the profession with a prominent symbol of their new status that bears their logo. For learners, as both a material object and as a hashtag, the backpack acts as a form of public identification with medicine: wearing a backpack renders them visible to others in and around Canadian healthcare as trainee members of the medical profession. Conclusion: Like the white coat and the stethoscope before it, the backpack has emerged as a symbolically potent material element of Canadian UGME. The backpack has substantial implications for how learners understand what it means to present as “professionals”; further work is necessary to continue parsing meanings bound up in #myCMAbackpack., Background/Purpose: Medical curricula are increasingly providing opportunities to promote, support and guide reflection in medical students. While our curricula are moving towards creating time and space to promote reflection, we do not fully understand the broader social influences that shape reflection. This study asked three questions a) How do learners use social networks to reflect on and make meaning of early significant clinical experiences? b) What do learners find valuable in these interactions? and c) What role do our formal curricula play in supporting learner reflection processes that might be social by nature? Methods: Using a phenomenological approach, individually generated sociograms provided a stimulus for narrative production in subsequent semi-structured interviews with first year medical students. Results: Learners described the importance of verbal processing within their social networks and engaging in dialogue around early significant clinical encounters. Strikingly, learners acknowledged a period of identity formation heavily influenced by networks as they sought to make meaning from early significant clinical experiences. Learners also struggled to find meaningful ways to involve their networks outside of medicine in their new experiences. They found some curricular opportunities such as reflective portfolio sessions to be useful, when deemed to be authentic. Conclusion: It is important to capture the role learners' social networks play in the support of their identity formation, as well as capacity for empathy and resiliency. Understanding this social phenomenon will provide us with a teaching language and framework that appreciates the profound role social relations play in students' meaning making of early significant clinical experiences., Background/Purpose: About 25% of physicians in Quebec do not create and maintain medical records properly according to our physician professional order (CMQ). Our organization had to develop an educational intervention to address this important unperceived gap, which was judged uninteresting as per participants. Summary of the Innovation: We created a 1.5-hour online knowledge self-assessment program. Coached by Hippocrates himself; participants must solve various vignettes developed from CMQ's medical record keeping regulations. A validated questionnaire based on the Theory of Planned Behavior was used to measure participants' behavioral intention post intervention. Launched in March 2016, 180 specialist physicians have registered to this course (completion rate: 74%). Participants agreed or totally agreed that a serious gaming approach was appropriated for this topic (95%) and all reported that this course met their learning objectives. Self-reported confidence to respect good practices in record keeping increased by 21%. 97% of the participants would participate again in a serious gaming CPD activity. A mean CPD REACTION score of 6.2/7 indicated that the program was efficient to promote participants' intention to respect good practices in record keeping. From the early development phase, we knew that meaningful vignettes were required to maintain participants' engagement. A CMQ representative was involved in the development of real-life scenarios. We also created a short humoristic and appealing video to facilitate recruitment. Conclusion: Using a serious gaming approach for this program convinced our organization that taking an unconventional educational path with our learners is feasible. We are now exploring broader instructional design avenues for upcoming programs., Background/Purpose: Continuing professional development (CPD) activities are an important aspect of lifelong learning. However, they often don't maximize potential for practice changes or measure their actual impact on practice. We developed an innovative 2-day multimodal CPD reality training activity in obstetrical ultrasound for small groups of obstetricians/gynecologists based on a competency-based approach including real life immersion. The aim is to describe practice changes identified by participants six months after training. Methods: Qualitative descriptive study with a convenience sample of 10 participants including 45-minute phone interview six months following training using a semi-structured interview guide. Verbatim transcripts were analyzed by two team members each using Miles, Huberman and Saldana's method. Consensus among all researchers was obtained. Results: All participants expressed changes in their ultrasound practice for the six main training objectives (image optimization, enhanced skills, fetal anatomy assessment, nuchal translucency measurement, exam reporting and genetic counselling). Most changes occurred immediately after the training and were maintained or still evolving. Other contextual factors mentioned as influencing practice changes included: initial experience level, self-directed learning skills, certification goal, colleague support, work-setting acceptance/resistance, resource availability, schedule limitations and population's needs. Conclusion: A multimodal CPD-reality training activity appears to have promoted rapid and consistent changes in practice despite other contextual factors. This type of activity offers a promising avenue for the development of other similar CPD activities that will ultimately facilitate practice change., Background/Purpose: Over one million Canadians have Class II or III obesity and are eligible to be referred by Primary Care Providers (PCP) for surgical and/or medical weight loss; however, fewer than 7% are referred. The purpose of this study is to explore the knowledge, experience, perceptions and educational needs of PCPs in managing weight loss in primary care to inform development of a Continuing Professional Development (CPD) event. Methods: Mixed method study combining a survey and focus groups with PCPs (n=591) in eastern Ontario. Survey data analyzed using descriptive and inferential statistics in SPSS. Thematic analysis utilizing an inductive approach completed on qualitative data through open coding with NVivo. Results: The survey was completed by 103 PCPs (17.4%). Overall, 39.1% had participated in education on the management of patients with obesity in the past 5 years, however 88.5% believe there is a need for education on bariatric surgery. Seven focus groups with 17 PCPs were conducted. PCPs described lack of knowledge as a barrier to managing obesity in primary care. Topics suggested for CPD included general information about bariatric surgery (procedures, referral process, post-operative follow-up, surgical complications), effective weight-loss strategies, and availability of local resources. Conclusion: Given the high prevalence of Class II and III obesity, PCPs are now key stakeholders for ensuring patients with obesity receive timely and high quality care. Understanding past experiences and perceptions of PCPs informed the development of a CPD intervention to support PCPs in providing quality and evidence-based care to their patients with obesity., Background/Purpose: There is little literature addressing the remediation of practicing physicians and even less investigating the unique role of practice remediators. As part of a larger program of research exploring social constructions of remediation in medicine, this study explored remediators' understanding of the remediation process through their stories of engaging with practicing physicians. Methods: Using experience-focused narrative research, we elicited the stories of nine clinicians in five provinces who had been asked by regulatory authorities to oversee the learning and practice of physicians with significant competence gaps. We analyzed their stories of particularly memorable remediation experiences using a hermeneutic approach. We explored the meanings that participants articulated about their work as remediators by iteratively reading their stories, examining the sense-making that participants achieved through these narratives, and identifying the roles and responsibilities participants described. Results: Participants' narratives articulated a wide range of roles, responsibilities and activities related to their remediation work. Remediators rhetorically positioned themselves as coaches and/or mentors. However, when engaging in remediation, they described practices and actions inconsistent with these roles, e.g. providing summative assessment for the regulator. Several people narrated poignant challenges for which they were unprepared. Conclusion: Ambiguities regarding the process of remediation manifested in our remediator participants as a lack of clarity, and some conflict, regarding their role when engaging with physicians requiring remediation. Faculty development might help, but more importantly, discussions regarding the nature and purpose of the remediation process are still needed across the profession., Background/Purpose: Studies that objectively assess the effect of Continuing Medical Education (CME) activities on clinical performance are lacking. This study sought to explore if participation in a series of cardiology CME activities has an impact in the lipid management that primary care providers (PCPs) deliver to their patients. Methods: This retrospective cohort study used a database of participation in cardiology CME activities (2011-2017) linked to electronic medical records of patients receiving care from 225 PCPs participating in the Manitoba Primary Care Research Network. Statistical analyses were completed using logistic regression with Generalized Estimated Equations. Results: Results indicated that after adjusting for relevant confounders, the odds of prescribing statins to patients with cardiovascular diseases (CVD), diabetes mellitus (DM) or chronic kidney disease (CKD) among PCPs who did not participate in the cardiology CME activities were 50%, 55% and 67% lower, respectively, compared with PCPs who participated in two or more activities. The odds of prescribing statins to patients with CVD and DM among PCPs who participated in only one cardiology CME activity were also 67% and 63% lower, respectively, compared with PCPs who participated in two or more activities. Conclusion: This study found that PCPs who participated in two or more cardiology CME activities had higher odds of providing recommended statin treatment to adults with CVD, DM or CKD. While there are several factors that might influence clinical decision-making, our results still suggest that participation in CME activities have a positive effect on clinical practice., Background/Purpose: Pelvic organ prolapse (POP) affects up to 50% of parous women causing significant morbidity. Vaginal pessaries are recommended as first-line management for patients with POP. Pessary fitting and Routine Pessary Care (RPC) are within the scope of practice of family physicians though training opportunities are limited, in part due to few family physician teachers. Furthermore, evidence confirms that continuing professional development (CPD) has little impact without practice-based reinforcement. To address this gap, we developed a competency-based medical educational (CBME) CPD to teach RPC to family physicians and evaluated its success using Kilpatrick model. We measured three outcomes: 1) physician participants confidence in providing and teaching RPC after the intervention and its maintenance over time compared to before attending this CPD; 2) whether or not participants provided RPC to their patients after attending this CPD; and 3) whether or not the quality of patient care was affected after this intervention. Summary of the Innovation: Eighteen academic family physicians participated in a two-hour simulation-based CPD session on RPC. We reinforced their training by incorporating a procedure template within their electronic medical record (EMR) and transferred the RPC care of their eligible patients from our women's health (WH) clinic to the Primary Care Provider (PCP) clinic of physician participants who completed this CPD. PROGRAM EVALUATION: We were interested in three outcomes based on level two to four of Kilpatrick model. First, we measured physician confidence (Kilpatrick level 2) in both performing and teaching RPC for four types of ring pessaries using a previously validated 5-point Likert-type confidence survey. (Rezaiefar et al 2018) As a control, we used the Gellhorn pessary, which was shown to participants during the CPD workshop but the skills to insert or remove it were not taught. Participants completed the confidence survey prior to, immediately after, and again 12 months after the simulation-based RPC workshop. Secondly, we assessed physicians' practice change (Kilpatrick level 3) by measuring the number of RPC related visits of participating patients at the PCP clinic and at the WH clinic in the one year before and one year after the intervention using a chart audit. Thirdly, we evaluated physicians' competence and patient outcome (Kilpartrick level 4) by measuring the quality of RPC provided to patients using a four point scale, assigning one point for each of the following items documented in the EMR clinical template: 1) Vaginal exam was documented, 2) Complications identified, 3) Complications managed according to the guideline and 4) Appropriate follow up recommended. Outcome: At the completion of this one year study 12 patient participants were receiving care from nine physician participants. We observed: 1) a significant improvement and maintenance of physicians' confidence in providing RPC (2.288, P < 0.001 and 1.727, P = 0.001) and teaching RPC (2.152, P < 0.001 and 2.106, P < 0.001) after the CPD and at one year respectively; 2) an increase in the number of visits for RPC care provided by PCPs (one year pre-intervention = 1%, one year post-intervention = 35%, P = 0.002) and a decrease of visits for RPC care to WHC (one year pre-intervention 30%, one year post-intervention 8%, P = 0.028) for patient-participants. The quality of RPC provided at PCP clinic was not inferior to WH clinic. Conclusion: Our proof of concept study offers evidence that CBME principle can be applied successfully to deliver procedural skills CPD programs. The incorporation of clinical EMR templates is an inexpensive and easily incorporated practice-based reinforcement strategy that may improve physicians' confidence and behavior change when putting a newly acquired procedural skill into practice., Background/Purpose: Accreditation of medical programs require schools to invest substantial resources in order to complete self-assessment activities, organize reviews, and engage in quality improvement activities to meet standards. In Universities offering several Health Programs, including medicine, having to meet accreditation standards from several accrediting bodies and engage in quality improvement, duplication of resources can be expensive. McGill's Faculty of Medicine chose to centralize these activities and resources under the Office of Accreditation and Education Quality Improvement (OAEQI). Summary of the Innovation: OAEQI uses a team-based approach to coordinate accreditation processes and support educational Q.I. activities. Teams are a blend of Academic and Administrative staff collaborating to provide individualized services to the Undergraduate and Postgraduate medicine, Nursing, Occupational and Physiotherapy and the Communications programs. The education teams function on a tripartite service model that aligns curriculum, assessment and evaluation to fulfill their mandate. Through this multidisciplinary relationship, the Office identifies clear and measurable outcomes to design and deliver individualized services. Conclusion: In a survey administered to PGME programs after the 2019 accreditation visit, over 80% of the respondents strongly agreed that because of the OAEQI services, they felt prepared to submit their accreditation documents and for their visit and interviews. 92% of the services were rated very or extremely useful. Finally, all respondents reported needing support from OAEQI to respond to accreditation results and implement quality improvement initiatives. Developing a centralized office to support Accreditation and Educational Q.I. activities allows for a more efficient, cost effective, use of resources and develops permanent and consistent expertise., Background/Purpose: CPD program and session evaluations are essential for (a) planning committees measuring a program's impact and planning relevant programs (Moore et al 2009); (b) presenters seeking feedback on educational content/delivery; (c) participants to reflect on their learning and application to practice (Armson et al 2015). For data to be valid, response rates must reach a critical threshold, which depends on session size (Nulty 2008). With electronic evaluations the norm, survey rates often low, and evaluation fatigue common, how can we leverage response rates to provide valid data? Summary of the Innovation: The NOSM CEPD Office has used a quality improvement approach, trialing different initiatives to increase response rates for electronic evaluations, including: a) Multiple access methods: sending evaluation links to participants' email; QR codes; “short links” b) Tent cards on session tables: providing visual reminders; simulating availability of paper evaluations c) “Reusable” evaluations: links participants use to evaluate multiple sessions successively d) Using the same evaluation link to generate electronic attendance certificates e) Academic detailing with speakers and planning committees to raise awareness on the critical role of evaluations f) Offering incentives (e.g., prize draws) for completion g) Designing evaluations to capture rich comments while maintaining high completion rates Conclusion: A multi-pronged approach works well to effectively reach faculty with diverse experiences and comfort with technology. Response rates for our annual faculty development conference (250+ participants) have exceeded 50%. Rates for individual sessions can reach 100%. It is vital to plan early, take the program's context into account, and identify ways to reduce evaluation fatigue., Background/Purpose: The College of Physicians & Surgeons of Alberta (CPSA) is the medical regulatory authority (MRA) in the province of Alberta, Canada. Along with other MRAs and stakeholders, the CPSA has helped to identify, research and explore various factors that may influence physician performance, including competence, individual factors and system-level factors. In 2016, the CPSA conceptualized a series of reports called “MD Snapshot,” designed as feedback, self-reflection and practice quality improvement (QI) tools. Utilizing the growing body of evidence around factors and the CPSA's own registration and prescribing databases, the “MD Snapshot-Practice Checkup” (Practice Checkup) and “MD Snapshot-Prescribing Profile” (Prescribing Profile) were developed. Summary of the Innovation: Practice Checkup is an annual factors-based personalized report for physicians, with the aim of promoting practice self-reflection and QI. Prescribing Profile is a quarterly personalized report for physicians containing numerous prescribing benchmarks. Prescribing Profile provides data apportioned into two domains: opioids (measured in total Oral Morphine Equivalents [OME] prescribed) and benzodiazepines (measured in total Defined Daily Dose [DDD] prescribed). Conclusion: Two years after the inaugural MD Snapshot reports were distributed, there was a 23% decrease in overall OME prescribed and an 18% reduction in overall DDD prescribed. This downward trend has been observed over each quarter since Prescribing Profile has been issued. Survey and focus group feedback indicates that the majority (>60%) of physicians agree that Practice Checkup promotes practice self-reflection. These innovations demonstrate that regulatory data may be used to influence and improve physician performance., Background/Purpose: Medical education experts suggest learner evaluations often do not significantly change faculty's teaching. Providing faculty development to distributed preceptors can be challenging. This project links concepts from quality improvement, communities of practice, and reflection on education practice to assess the impact of a workshop using learner evaluations to stimulate teaching improvements. Methods: A faculty development workshop based on grouped, anonymized evaluations was offered to Northern Ontario Local Education Groups (LEGs). LEGs are key to delivering undergraduate and postgraduate educational activities at NOSM and function as communities of practice. Participants reviewed strengths and areas for improvement; discussed individual and group-based improvement strategies; and completed intention to change declarations. Follow-up surveys and interviews assessed impact. Results: Eleven workshops with LEG membership of 291 representing 25% of NOSM's clinical faculty participated, including rural and urban LEGs; small and large LEGs; family medicine and specialty LEGs. Common themes such as improving learning orientation and providing regular feedback emerged across multiple LEGs. Weaknesses unique to specific LEGs were also identified including appropriate response to learners' negative experiences and how to manage patients with learners. Outcomes include individual faculty changes (e.g. eliciting feedback; clarifying learning objectives) and LEG-based changes (e.g. new tools, processes, assessments). Faculty responded positively and report increased awareness of their LEG as a Community of Practice. Conclusion: Learner evaluations provide opportunities to engage faculty individually and within a community of practice to implement meaningful improvements to their teaching practices., Background/Purpose: Integration of Quality Improvement (QI) into competency frameworks requires appropriate educational initiatives across the medical education continuum. There is a need for evidence regarding the content, format, and process pertaining to QI teaching throughout medical training. The purpose of this study was to explore the contextual factors, mechanisms, and predictors of success that support QI learning in medical education. Methods: A realist review of peer-reviewed and grey literature on the topic of QI in medical education was conducted with the aim of identifying what works, for whom, in what circumstances, and why. No date or methodological filter was used, rather, relevance to the research question was used to identify articles which could strengthen and interrogate a program theory. Results: After two reviewers screened 18854 unique records, seven reviewers screened 609 full-text records for eligibility and extracted 358 studies. The majority of QI curricula occurred at the postgraduate level in the United States using ambulatory contexts for experiential learning. At the undergraduate level, curricula often combined didactic and experiential learning during clerkship. Longitudinal curricula or scholarly tracks that ran throughout the entire medical curricula were common. Contextual factors included supportive environments with pre-existing QI culture, alignment with hospital goals, and using continuity clinics for projects. Mechanisms included: mentorship; curricula with clear objectives, deliverables, and constructive feedback. Conclusion: Contexts and mechanisms identified from this synthesis can foster QI learning during training. The results of this research can help guide the development and implementation of QI programming across medical schools and residency programs., Background/Purpose: Formal training in Quality Improvement (QI) may help to ensure that physicians are equipped with the knowledge, skills, and attitudes to implement system-level solutions that improve the healthcare system. Yet, training in this area is not consistent across postgraduate programs. The purpose of this study was to explore how residents learn about QI. Methods: Four data sources were analyzed to explore how residents learn about QI: surveys, interviews, observations, and archival records. 182 residents from four programs completed survey with over 130 items, 23 residents and 6 faculty completed an individual, semi-structured interview, 27 hours of observations were completed, and 5 years of archival records were analyzed. Results: Residents with formal QI curricula reported higher knowledge, skills, and attitudes as well as motivations to make improvements throughout their careers. Effective components of QI curricula included: 1) accessibility of microsystems which foster a positive culture for QI, 2) mentorship from faculty and QI champions, 3) clearly defined objectives and deliverables, and 4) protected time to support residents in their QI activities. Residents without formal QI curricula reported their deficiency in QI training were due to their program's research requirement, which was commonly perceived as a “checkbox.” Conclusion: This study highlights the need for formal QI training that provides residents with meaningful opportunities to improve care and structure within their curriculum to both learn and apply QI concepts. Results of this study can inform the development of educational programming in competency-based models of training that will meet the needs of learners., Background/Purpose: Starting in October 2018, students in year 1 (Y1) and year 2 (Y2) of the MD Program at the University of Toronto submitted unplanned and planned absence requests using an online Absence Request Form. This system has allowed the MD Program to track absence requests from mandatory activities and respond to students absence requests effectively. We investigated the correlation between the number of absence requests and various quantitative assessment data to explore the relationship between attendance and student academic success in two cohorts of undergraduate medical students. Summary of the Innovation: A review of the data revealed that 522 students requested 2525 absences (84% unplanned absences). The average number of absences per student was 4.66 (SD = 3.49) for Y1s and 4.97 (SD = 3.68) for Y2s. The largest unplanned absence category was for illness/injury (41%), followed by self-care (32%). The largest planned absence categories were academic presentation at a conference (4%) and absences due to significant events (4%). The number of absence requests was negatively correlated with scores on Mastery Exercises (R = -0.11, p = 0.045), Anatomy Bell ringers (R = -0.21, p < 0.01), OSCEs (R= -0.29, p < 0.01), and the Progress Test (R = -0.28, p < 0.01). Conclusion: A high rate of attendance is key to the success of trainees in the highly-integrated Foundations (Preclerkship) curriculum. Further improvements to the absence tracking system will be key in further supporting our students individually and identifying absence trends that will allow the MD Program to address both acute and long-term curricular gaps., Background/Purpose: This study establishes by expert review a consensus-based, focused point-of-care ultrasound (POCUS) curriculum, consisting of a foundational set of POCUS skills that all Canadian medical students would be expected to attain at the end of medical school. Summary of the Innovation: An expert panel of 21 POCUS and/or educational leaders representing 15 of 17 (88%) Canadian medical schools was formed and participated in a modified Delphi consensus method. Experts anonymously rated 195 curricular elements on their appropriateness to include in curriculum using a Likert scale. The group defined consensus as 70% or more experts agreeing to include or exclude an element. We determined a priori that no more than three rounds of voting would be performed. Of the 195 curricular elements considered in the first round of voting, the group reached consensus to include 78 and exclude 24 elements. In the second round, consensus was reached to include four and exclude 63 elements. In the final round, with one additional item added to the survey, the group reached consensus to include an additional three and exclude eight elements. A total of 85 curriculum elements reached consensus to be included, with 95 to be excluded. Sixteen elements did not reach consensus to be included or excluded. Conclusion: The CanUCMe Group recommends by consensus 85 curricular elements be considered for inclusion for teaching in the Canadian medical school POCUS curricula., Background/Purpose: Problem Based Learning (PBL) pedagogy utilizes patient scenarios to stimulate students to link new knowledge to existing cognitive networks, reflect on/design learning objectives, research material, and co-construct knowledge. PBL supports learning, retention, contextual transfer, collaboration, self-directed learning, and cultural and ethical competencies. Primarily from traditional curricula, entering medical students' transition to PBL with its focus on collaboration, co-creation, and constructive cognitive conflict, compounded by lack of familiarity with PBL process and expectations, has resulted in anxiety and uncertainty. Rather than starting with standard PBL, a scaffolded introduction was designed. Summary of the Innovation: Introduction to Medicine is the first subunit of the renewed Undergraduate Medical Education curriculum at McMaster University. Learning themes included: learning process, communication, professionalism, and wellness, based on student and faculty feedback, published and grey literature, and expert input. After an interactive introduction including video modelling about the rationale and process of PBL, 6-7 tutorial groups were placed in one classroom with 3-4 experienced tutors circulating. One facilitator directed structure/debriefs for major steps in PBL process, scaffolded over 4 sessions. The final session replicated a standard tutorial. Objectives added to standard scenarios included: self-reflection, participation, goal setting, learning strategies, and feedback. Concurrent curricula supported students' learning. Conclusion: Formal and informal feedback supported growth in PBL skills. Students' affirming experiences including comparing objectives with other groups and clarifying challenges, improved cohesion and reduced tension. Tutors reported shared understanding, improved consistency, validation, and real-time peer support. Future directions include refinement of learning structure, integration of non-medical expert competencies, supporting curricula, and handover to standard tutors., Background/Purpose: Medical students hold themselves to higher standards than their supervisors and underrate their performance compared to external measures. While these inaccuracies can impact wellness and create roadblocks for learning, our understanding of these tendencies remains limited. Uncovering the factors that drive medical students' (mis)perceptions may better position faculty to mitigate these detrimental effects. Methods: Eleven medical students in years 1-3 participated in semi-structured interviews to discuss how they self-assess and set performance standards. Constructivist grounded theory guided the iterative data collection and analytic process. Results: In the absence of clear expectations and useful feedback, participants described using perceived external expectations, peer comparison, and their personal values to set performance standards. Participants saw their performance as suboptimal if they did not expertly grasp clinical knowledge, demonstrate confidence, or flawlessly execute examination checklists. When their performance fell short of their personal standards and perceived expectations, participants reported experiencing increased stress, anxiety, and self-doubt. Several participants identified structural biases as a prominent factor that exacerbated pressures to excel. Conclusion: Medical students gauged success by measuring their performance as clinicians rather than their gains as learners. Faculty should encourage medical students to develop their learner identity by setting clearer standards, providing reflective feedback, and normalizing learning through failure. The impact of structural biases on performance should also be considered. Such efforts can help trainees develop into lifelong learners with sustainable careers in medicine., Background/Purpose: Portfolios are intended to provide safe, non-judgemental, and confidential environments to encourage reflection in undergraduate medical education (Belcher et al 2014). With the debut of competency-based education, portfolio has been increasingly utilized to help monitor progress toward exit competencies (Kjaer et al 2006; Lewis & Baker 2007). While students' perceptions of portfolio have been studied in an isolated time frame (Driessen et al 2005), this study examines fourth year students' perceptions of a reflective portfolio and the evolution of their perceptions over the four years of medical school. Methods: We conducted semi-structured interviews with 17 fourth year medical students at the University of British Columbia. The interviews were recorded and transcribed verbatim. We analysed the data using the thematic analysis framework outlined by Braun and Clarke (2006). Results: We identified several recurring themes. (1) Students valued the randomly allocated groups for the diversity of perspectives afforded. (2) Student perceptions of portfolio evolved from one of relationship building, in the pre-clinical years, to one of professional development. Consequently, students highly valued continuity of groups and coaches. (3) Students elucidated key factors for developing effective coach-student relationships including coach willingness to exhibit personal vulnerability and authenticity as well as flexibility in discussion topics. Conclusion: Our data suggests that the perception of a reflective portfolio changes over time, particularly in the transition into clinical training. Further, students valued longitudinal relationships that developed with peers outside their social networks. Finally, students expressed key factors for successful student-coach relationships., Background/Purpose: Lights! Camera! Action! The use of these elements propelled the transformation of an “Electronic Clinical Resources” lecture for medical students to an engaging show production. Variation in classroom lighting, video-assisted content delivery, and in-class games were built into the lecture gradually, over three years. Traditionally, lectures on library resources (e.g. how to use databases to search up clinical queries) were not highly rated, as students may consider the subject “drier” than other medical topics. An immersive, educational “production”, rather than a regular lecture, may improve learning and retention through active learning and emotional simulation. Summary of the Innovation: The lecture underwent 3 annual revisions (2017-2019). In 2017, a “Fast Finder” game was added to the second half of the lecture. This game required teams of students to compete against other teams to answer as many multiple-choice questions as they could in 15 minutes; students used electronic clinical resources, covered in lecture, to answer clinical questions. In 2018, additional practice questions were integrated throughout the first half of the lecture, using an online medium, Kahoot, as a delivery mechanism. The second half involved a “Fast Finder” activity again, but students competed individually instead of on teams, and questions were delivered through Kahoot. In 2019, the answering mechanism for the practice questions was through holding body poses (to represent A, B, C, or D). The “Fast Finder” component reverted back to the team-based game of 2017. The first half of the lecture was transformed into a show, where the classroom functioned as “HQ”, and the facilitators communicated to secret spies “live on location” through a video-feed (pre-recorded movie). Conclusion: With each subsequent year, session ratings improved. The 2016 lecture facilitation was rated 3.73/5 by students in the end-of-course evaluation. The revised sessions of 2017, 2018, and 2019 scores were 4.19, 4.25, and 4.47 out of 5, respectively. Lesson-planning is similar to show-producing. Adding themes, showmanship, and interaction can increase audience immersion and satisfaction. With a bit of creativity and openness, any medical school lecture has the opportunity to transform into an educational “show” to better engage students cognitively and emotionally., Background/Purpose: Despite efforts to address healthcare distribution inequalities across Canada through physician recruitment, studies have demonstrated that physician attrition is higher in rural regions, indicating retention and recruitment are separate issues. In this study we aim to identify qualitative differences in attitudes towards physician recruitment and retention from a group of South Western Ontario (SWO) community physicians based on service length. Methods: We developed a semi-structured interview guide and conducted telephone interviews with 28 SWO community physicians. Physicians were separated by service length and defined as LS (longstanding physician, >5 years at practice location, n=14) and RR (recently recruited physician, Results: When asked about factors influencing their current practice location, LS and RR mentioned scope of practice and collegial support. RR exclusively mentioned community familiarity as a barrier to recruitment, while LS emphasized burnout/distress as a barrier to retention. Both groups talked about their residency as a key facilitator, however RR to a much greater degree. LS often discussed family satisfaction and autonomy as facilitators to retention, both of which RR rarely discussed as facilitators. Conclusion: While these groups shared overlap in their perceptions, there are clear differences in their attitudes towards factors keeping them in their practice location. RR valued their educational experience and support with transition to practice, while LS emphasized community integration and flexibility in practice. These factors provide avenues to address immediate and long-term physician need., Background/Purpose: Medical education exists to improve patient care, yet most education research is not situated within clinical practice. As a consequence, researchers have struggled to demonstrate that education impacts patient outcomes. Prescribing error in children is a case in point, continuing to cause harm for patients and anxiety for physicians, despite concerted efforts at improvement. This study aimed to generate evidence to inform prescribing education by developing an in-depth understanding of the behavioural causes of errors occurring in authentic clinical practice. Methods: Qualitative evaluation of a large dataset of reported prescribing errors in children in secondary care, using critical realist causal logic and the Capability-Opportunity-Motivation-Behaviour (COM-B) theoretical model. Results:460 reported errors contributed to analysis. A range of prescribing behaviours, such as not checking resources or not involving patients, led to errors. Behaviours were determined by highly-interrelated elements such as prescribers' lack of pediatric experience, insensitivity to risks, fragmented, unsupportive workplaces, and the specific demands of prescribing tasks. Conclusion: This study reveals the complex, wide-ranging causes of prescribing errors in children. It points to a need for sophisticated educational strategies that account for prescribing complexity, such as authentic, contextualised modes of feedback, interprofessional education geared towards collective performance, and measures to expand the role of patients in supporting safe prescribing. This study's approach - using data derived directly from practice and focusing on prescribing behaviour - offers the potential to directly benefit patients., Background/Purpose: Professional organizations emphasize the importance of the primary-specialty care interface (PSI) especially for patients with chronic diseases. Despite the abundance of research to improve communication within the PSI, persistent tensions negatively impact medical education and patient care. There has been a dearth of theoretically-informed research exploring how structural, organizational and system-level factors influence the PSI. Methods: Using diabetes as a case, we conducted a Foucauldian discourse analysis of policy, professional and educational documents, and interview transcripts with a purposive sample of primary care and specialist physicians. By analyzing the PSI as a discursive construction we sought to explore what is actually happening in efforts to improve the PSI (including the unintentional effects) and the potential consequences for education and patient care. Results: The PSI is constructed in a way that privileges a disease-centric approach to care. Specialists occupy a position to correct the practices of problematic primary care physicians, whose expertise in managing uncertainty, complexity and relational care is relatively obscured. However, physicians described teaching and implementing initiatives to improve the PSI that may be unintentionally preventing socially marginalized patients from ever receiving care. Conclusion: While efforts to improve the PSI are adopted and taught with the best intentions, our analysis suggests they may prevent development of the relationships between primary care and specialist physicians necessary for the delivery of quality patient care. Making explicit the implicit assumptions about the PSI opens space for educators to see and develop new ways of thinking about and teaching collaboration as a competency., Background/Purpose: Language and representation matter. For almost one-hundred years, the Faculty of Medicine at the University of Toronto has produced an annual report from the Dean, discussing pertinent issues, showcasing successes and acknowledging community members. The reports have traced the history of the faculty through the wars, the Great Depression, and the introduction of socialized medicine. Included in those narratives are the people who work within the Faculty as staff members, teachers, researchers, and leaders. This study forms the beginning of my doctoral thesis research employing Foucauldian discourse analysis to explore how administrative staff have been and continue to be represented across three departments in the Faculty of Medicine. Methods: Fifty years of digitalized Reports from the Dean written between the 1920s and the 1970s form the archive and were reviewed, coded in NVivo12, and analyzed using Foucauldian discourse analysis techniques. Results: Staff and Faculty have been written about differently in the Reports and this changes over time. Staff representations are minimal with specific named administrative staff mentioned very rarely. This is juxtaposed by the heavy focus on named Faculty members. Staff are constructed in various ways, typically using aspects of their personal dispositions. In contrast, faculty are constructed more so for their accomplishments or the esteem held by others. When faculty are constructed using aspects of their personal dispositions, this is often gendered. Conclusion: How staff and faculty have been constructed through these texts hint at the differential power ascribed to these groups. Further phases of this research will further explore the discourses that govern this differential power., Background/Purpose: Increasing the research capacity of physicians located in distributed sites (DS) enables the Schulich School of Medicine & Dentistry to encourage research and help advocate for community patient populations in an era of declining clinician-scientists. DS physicians face unique challenges which may act as barriers, including patient expectations, time, resources, and support. In this study, we aim to identify and compare barriers and facilitators to engaging in research for Schulich DS or academic centres (AC) physicians. Methods: We developed a semi-structured interview guide querying research history, training, and research capacity. In-person interviews were conducted with 68 Schulich physicians (14 AC & 54 DS) then transcribed verbatim and analyzed in an immersion and crystallization framework. Results: A total of 6 themes were found including time, research training, resources, clinical impact, organization, and character. Themes spanned 35 unique codes. Time was the largest barrier to both AC & DS physicians, however DS physicians often listed their organization as a barrier, while AC physicians only mentioned this as a facilitator to research. AC physicians felt access to resources was a key facilitator, while DS physicians more frequently mentioned resources as a barrier. Conclusion: DS physician's perception of research is unique compared to AC physicians. While barriers including professional time and work-life balance are difficult to remedy at the institutional level, differences in barriers emphasized by DS and AC physicians such as non-clinical network or collaboration are factors that provide Canadian medical schools practical targets to enhance the research capacity of faculty in distributed sites., Background/Purpose: This study concerns the Certificates of Added Competence (CAC) program initiated to increase enhanced skills training for members of the College of Family Physicians of Canada (CFPC). The current study is policy-responsive work performed in partnership with the CFPC, to explore the impact of four CACs on the provision of comprehensive primary care in Canada. Methods: This mixed-methods study uses six qualitative case studies and a national survey to investigate the way that CACs in Care of the Elderly, Palliative Care, Anesthesia, and Sports and Exercise Medicine impact the organization and delivery of family medicine across Canada. Cases are conceptualized as groups of family physicians who work in an inter-connected way; cases were selected to represent diversity in geography, patient population, and practice arrangement. In each case, we conducted qualitative interviews, within-case focus groups, and review of relevant documentation. A descriptive content analysis was performed, within and across cases and informed the development of the survey. Results: Through a unique combination of enhanced expertise in specific domains of care and a grounding in the principles of Family Medicine, CAC holders act as a bridge for patients between family physicians and specialty care, extending both the comprehensiveness and continuity of care provided by family physicians in a community. Conclusion: Through this research, we seek to provide an improved understanding of the impact of CACs and to give advice to the CFPC about whether, and how, to implement additional CACs in service of providing access to co-ordinated and community-adaptive comprehensive care., Background/Purpose: Structured oral examinations (SOE) are often used to assess clinical reasoning and are an important element in a comprehensive program of assessment. However, knowledge about stakeholders' perceptions of SOE is limited at the undergraduate medical education (UGME) level. We therefore explored stakeholders' perceptions of the SOE, as part of an assessment program. Methods: We recruited stakeholders from one Canadian university to participate in a qualitative descriptive study. We collected data through focus groups with learners (n=5) and assessors (n=3), and analyzed it using Miles, Huberman and Saldana's method. Two team members carried out the analysis for each transcript and all team members discussed the interpretation until a consensus was reached. Results: Thirty-eight learners and ten mentors participated in the study. We identified several positive perceptions of SOE (e.g., authenticity of the format to represent real clinical work, allows for the assessment of clinical reasoning) and some negative consequences (e.g., stress and anxiety due to the format and time allowed, disappointment linked to not receiving feedback). The flexibility of the format was seen as both positive (could have a face-to-face interaction with the rater) and negative (perceived subjectivity and lack of standardization). Conclusion: The perceived positive aspects of SOE seems to outweigh the perceived potential negative ones. Thus, overall, our results support the continued use of SOE as a modality to assess clinical reasoning within a UGME program of assessment. Considerations should be given by the individuals responsible for the exam to minimize the perceived potential negative consequences., Background/Purpose: Memorial University introduced Entrustable Professional Activities (EPAs) into an undergraduate clerkship curriculum as formative assessments. This study applies the Norcini et al. (2018) consensus framework for good assessment to evaluate a mobile system in assessing undergraduate EPAs during clerkship. Methods: An electronic clinic card was developed for mobile use by both clerks and preceptors. Clerks were tasked with transcribing in-the-moment coaching and assessment discussions with preceptors. Assessments were collated and analyzed by ordinal regression, and users were surveyed on satisfaction with the new modality. Results: The mobile eClinic Card system enabled 80 clerks and 624 preceptors to document 6,850 submissions that included 18,661 EPA scores across 47 clinical sites over a 48-week core clerkship curriculum. The rating system was found to be generally consistent, reliable and equivalent between preceptors, clinical sites, or the specific activity assessed. Clerks documented progressive improvement. Some differences between disciplines were found in rating odds, in preceptor composition and workload. Student odds of success did not correlate to subject examination scores. Preceptors and students were satisfied with ease of use and dependability of the eClinic Card mobile app; however, clerks suggested the quality and utility of formative coaching feedback could be improved. Preceptors felt enhanced faculty development would be beneficial. Conclusion: Findings support the utility, feasibility and acceptability of a mobile system in assessing work-based Entrustable Professional Activities within clerkship curriculum. Change management is a major determinant of success and user engagement is essential for uptake of mobile technologies for work-based assessment., Background/Purpose: Learner handover (LH), or forward feeding, can support longitudinal assessment in rotation-based systems, but concerns have been raised. Because successful implementation relies on a better understanding of existing practices and beliefs, our purpose was to explore how faculty perceive and enact LH. Methods: Using constructivist grounded theory, we conducted 23 semi-structured interviews with faculty from two universities, asking participants to describe their LH practices. We probed to understand why LH was used, its perceived benefits or risks, and the socio-cultural influences on faculty LH practices. Results: While participants reported that LH was motivated by both learner benefit and patient safety, they primarily described motivations focused on their own needs. LH was used to improve faculty efficiency by focusing teaching and feedback, and it was perceived as a “self-defence mechanism” when faculty were uncertain about a learner's competence and trustworthiness. LH also served social or therapeutic purposes when faculty used it to gossip, vent, or manage insecurities about their assessment of learner performance. Because of its multiple, sometimes unsanctioned purposes, some participants advised being reflective about the motivation behind LH conversations. Conclusion: Efforts to improve LH currently center on developing formalized learner-centered processes. However, our findings suggest that LH tends to be faculty centered. While sharing information may create biases that harm learners, LH may be one of the few avenues available for faculty to share anxieties around entrustment. We suggest that any LH processes should consider faculty needs prior to implementation., Background/Purpose: Pediatric UGME at the University of Manitoba assesses incidence of witnessed and experienced clinical clerk mistreatment during the pediatric clinical rotation. Interventions were implemented to address mistreatment involving nursing colleagues. We assessed the effectiveness of these interventions. Methods: Student reports of mistreatment during the pediatric clerkship were obtained during exit interviews administered by the director and associate director. Data over six years was assessed for clinical group involved in the complaint, and stratified by period in which the alleged event(s) took place. One-way ANOVA and post-hoc Tukey identified that complaints of observed mistreatment by nurses were statistically different compared to every other group. Complaint frequency was assessed in a run chart. Results: Complaints were reported by students experiencing workplace mistreatment 26 times, the majority of which involved residents (44%), allied health (17%) and nursing (17%). Bystanders registered 34 reports of mistreatment, the majority of which involved nursing (46%), allied health (23%) and residents (16%). One way ANOVA with post-hoc Tukey analysis revealed that only bystander complaints of nursing associated mistreatment were statistically significantly higher (p = 0.001) to all other groups. Nursing associated mistreatment complaints were most prevalent during January - mid February. Finally, assessment of complaint frequency shows significant decrease since interventions have been implemented. Conclusion: Medical student harassment is a serious problem in training. Since interventions have been put in place, we have seen a reduction in both observed and experienced workplace student mistreatment. We discuss the interventions that were implemented., Background/Purpose: Inadequate documentation of trainee underperformance persists despite research-informed solutions targeting this failure-to-fail phenomenon. Documentation could be impeded if assessment language is misaligned with how supervisors conceptualize underperformance. Since frameworks tend to itemize competence while being vague about incompetence, assessment design may be improved by better understanding how supervisors experience being confronted with an underperforming trainee. Methods: We interviewed 22 physicians about their experiences supervising trainees who demonstrate incompetence. Following constructivist grounded theory, the interviews were conducted and analyzed iteratively. Results: Physicians began with an assumption: all trainees should be capable of progressing by applying learning to subsequent clinical experiences. Underperformance was therefore unexpected, and evoked disbelief in supervisors, who sought alternate explanations for the surprising evidence. Supervisors struggled to explain underperformance, often due to limited interaction time, and offered two main explanations: underperformance was being unable to engage with learning due to illness, life events, or learning disorders so that progression was stalling or stalled; or it was being unwilling to engage with learning due to lack of interest or insight. Once underperformance was identified, some physicians were compelled to flag stalled trainees to get them help and to flag disengaged trainees to protect patients. Conclusion: Physicians conceptualize underperformance as failed progression that cannot be recovered through supervision. Although failure-to-fail tends to be framed as a reluctance to document underperformance, the prior step of identification may be hampered by brief, isolated supervisory relationships that do not allow sufficient interactions to make sense of unexpected trainee performance., Background/Purpose: Written comments are gaining traction as robust sources of assessment data. Compared to the structure of numeric scales, what faculty choose to write is ad hoc, leading to idiosyncratic differences in what is recorded. We explored what aspects of writing styles are determined by the faculty offering comment and what aspects are determined by the trainee being commented on. Methods: We compiled in-training evaluation report (ITER) comment data from all faculty providing at least 8 ITERs at four large North American Internal Medicine training programs. Data were analyzed using the Linguistic Index and Word Count (LIWC), which categorizes and quantifies written language. Generalizability Theory was used to determine whether faculty could be reliably discriminated from one another based on writing style; correlations/ANOVAs were used to determine what styles were related to faculty or trainee demographics. Results: Each dataset contained data from a range of 23-142 faculty who provided 549-2666 assessments on 161-989 trainees. Faculty could easily be discriminated from one another using a variety of LIWC metrics including Word count (G=0.79), Words per sentence (G=0.76), and the use of “Clout” words (G=0.71). These patterns appeared person-specific and did not reflect demographic factors such as gender or rank. These metrics were similarly not consistently associated with trainee factors such as PGY, gender, or the numeric score. Conclusion: Faculty seem to have detectable writing styles that are relatively stable across the trainees they assess. If written comments are to meaningfully contribute to decision-making we, need to understand and account for idiosyncratic writing styles., Background/Purpose: Medical students receive limited exposure to substance use disorders (SUDs) throughout their undergraduate medical training, despite its prevalence in society. At the University of Toronto, a week-long extra-curricular program in addiction medicine was developed to enhance SUD knowledge, skills and attitudes toward managing patients with SUDs. The program was available to all pre-clerkship students; 20 individuals applied. Of these students, 13 participated. Summary of the Innovation: The novel curriculum included half didactic and half clinical shadowing experiences. Didactic lecture and workshop topics included: the biopsychosocial model of addiction, motivational interviewing, harm reduction care models, naloxone training and stigmatization of addiction disorders. The clinical course component involved placements at residential treatment facilities, in-patient hospital services, rapid access clinics and specialty addiction medicine placements (e.g. substance use in pregnancy clinics). The curriculum was evaluated using a mixed-method design (surveys, a focus group and a written reflection). Conclusion: Participants reported high program satisfaction, and felt the clinical exposure was invaluable for skills building, career exploration, and understanding stigma and the patient experience. Moreover, participants felt that program stimulated personal and professional growth, and introduced them to forms of advocacy for this vulnerable population. Key learning points included prioritizing patient and family member perspectives, and providing diverse modalities of learning to highlight the different aspects of the biopsychosocial model. Overall, participants felt the week would initiate a change in their future practice, and felt that all medical students should have similar exposure to addictions medicine., Background/Purpose: Limited English-proficient (LEP) patients have adverse health outcomes, including increased emergency room visits, diagnostic tests, and misdiagnoses. Toronto is a multi-cultural city with a quarter million mandarin speakers, and the Medical Mandarin Education Program (MMEP) was developed in 2018 to address observed communication difficulties between healthcare providers and Mandarin-speaking patients. MMEP provides a supportive extracurricular environment for MD students to learn and practice medical Mandarin with peers. Summary of the Innovation: From August 2018 - May 2019, we piloted ten 1-hour long sessions with 25 unique 1st and 2nd year MD students. Eight student-led sessions taught content paralleling the Foundations pre-clerkship curriculum via topic vocabulary words, sentence translations, and practice cases. Two physician-led sessions promoted cultural understanding and personal practice tips. Following program completion, we conducted two 45-minute, audio-recorded focus groups with 6 participants each. Transcripts were iteratively examined via descriptive thematic analysis. A post program survey investigated participant demographics and experiences. Conclusion: MMEP was well received by students, who noted appropriate material length and difficulty. 90% of participants were intermediate/fluent Mandarin speakers; yet only 25% were comfortable using it in a clinical context. MMEP addresses this language gap. Perceived program impacts include increased comfort with and likelihood of using clinical Mandarin in future patient care, a developing sense of peer linguistic and cultural community, and increased understanding of cultural diversity. Program information is being disseminated to students and schools interested in minority languages and cultural competencies., Background/Purpose: In 2014 the University of Toronto launched a multi-site, urban longitudinal integrated clerkship (LInC), encompassing all medical disciplines. After expanding to 10% of the class in seven sites, this pilot program was terminated in 2018. This descriptive study outlines the reasons for the program's discontinuation using an organizational processes framework. Methods: As co-creators of the program, we identified several factors that led to the program's collapse. Based on our observations and qualitative analysis of focus group transcripts, we have described our findings related to the structural, human resource, symbolic and political challenges. Results: Structurally, the co-existence of LInC and block clerkship within the same hospitals created confusion and competition for scarce clinical resources. From a human resource perspective, the creation of personalized daily schedules for each LInC student carried a significant administrative burden. Symbolically LInC represented the promotion of heightened humanism in medicine. Paradoxically this holistic emphasis was perceived as both less rigorous compared to traditional block clerkship, and as an invalidation of block student interpersonal skills. Politically, LInC created issues of equity among the medical school class, due to the significant resources allocated to a small minority of the class perceived as being treated preferentially. Conclusion: LInC challenged the culture of our large, traditional medical school. Despite the program being highly successful clinically, asking students to choose between two parallel clerkship curricula co-existing in the same institution proved unsustainable. We are planning on bringing the most impactful elements of the program to the entire medical school class., Background/Purpose: At CCME 2018, the 16 Canadian Faculties of Medicine endorsed the creation of a national electives policy. This policy would enforce a maximum of eight weeks in any entry-level discipline, with the goal of diversifying clerkship training and promoting parallel career-planning. Medical students are facing significant concern over the increasing number of unmatched Canadian Medical Graduates. When the national electives policy was first introduced at McGill, student response was subjectively negative. We thus sought to elicit both quantitative and qualitative feedback, with the goal of advocating for the student perspective prior to and throughout policy implementation. Methods: Two anonymous online surveys were sent to all McGill medical students in September and December of 2018. Narrative feedback was collected in four town hall meetings. Results: Seventy percent (First survey, N=165) and 66% (Second survey, N=179) of survey respondents voted in favor of the national electives policy. Students expressed support for the following reasons: 1) Uniformity across Canada; 2) The opportunity to pursue multiple career paths; 3) Predicted financial benefits due to perceived decreased travel needs. Students reported concerns regarding the following issues: 1) Potential decreased exposure to clinical supervisors; 2) Uncertainty about residency selection criteria; 3) Concern for country-wide policy enforcement. Students were tentative with regards to implementation of the policy. Conclusion: Despite the initial negative response, McGill students were predominantly in favor of the national electives policy. Given the shifting Canadian landscape of residency positions, students expressed interest in maintaining collaboration with policy-makers throughout the implementation and review process., Background/Purpose: The purpose of this study was to assess if having completed a psychiatric clerkship or having increased exposure to mental illness in general was associated with reduced explicit and implicit stigmatizing attitudes towards mental illness in undergraduate medical students. Methods: A secondary analysis of data specific to medical students from McMaster University was completed. Data were obtained through a cross-sectional survey administered electronically. The survey consisted of a demographic questionnaire, the Opening Minds Scale for Healthcare Providers (OMS-HC) 12-item survey, and an Implicit Association Test (IAT). The OMSHC was used as a measure of explicit stigmatizing attitudes, whereas the IAT was used as a measure of implicit bias. All analyses were completed using Stata/IC 15 and were two-tailed with significance defined as p < 0.05. Results: Individuals that self-reported either having had a mental illness or diagnosis by a health care professional had significantly lower levels of explicit stigma. Final-year medical students had significantly lower levels of implicit stigmatizing attitudes than first-year medical students. Neither having completed a psychiatric clerkship nor having a close relationship with someone experiencing a mental illness was significantly associated with the explicit or implicit stigmatizing attitudes of medical students. Conclusion: More years in medical school and self-identifying or receiving a diagnosis of mental illness are associated with reduced stigmatizing attitudes, whereas having completed the psychiatric clerkship and having a close relationship with an individual experiencing mental illness were not. This study suggests that the psychiatric clerkship may have limited impact on the stigmatizing attitudes of medical students., Background/Purpose: To address the minimal exposure to critical care specialties in pre-clerkship curricula, we implemented an intensive one-week critical care program for pre-clerkship students. The goal was to increase pre-clerkship students' self-assessed knowledge, interest and confidence in the critical care specialties. Methods: Pre-clerkship students participated in the REACT (radiology, emergency medicine, anesthesiology, critical care and traumatology) pilot program, consisting of observerships, career discussions, and hands-on simulation across the selected acute care specialties. This prospective cohort study evaluated the effectiveness of the REACT program in improving critical care knowledge and facilitating career planning when compared with a control group. At baseline and completion, students completed a survey assessing specialty interest, self-assessed knowledge, and confidence of the simulated skills. Results:29 pre-clerkship students were recruited, 15 participated in the REACT program. No significant differences in study measurements were noted between the study arms at baseline. At program conclusion, REACT participants showed increases in nearly all study outcomes compared to baseline and the control group. Significant increases were noted in specialty knowledge, career interest (anesthesia only), and procedural knowledge/confidence (p Conclusion: The REACT program was effective in increasing interest, self-assessed knowledge and confidence in the critical care specialties. This program can be expanded to other medical schools to grant early exposure to critical care specialties., Background/Purpose: The Canadian health system is vulnerable to disruption by exponential advances in technology and differing work expectations from incoming physicians and patients. A principle that is likely to persist for health-related stakeholders is the provision of accessible and personalized health care services to all Canadians. Physician resource planning (PRP) is a crucial component in ensuring the right mix, distribution, and number of physicians needed by society. Currently, each province approaches PRP differently as there is no official national oversight. This results in some provinces that report data publicly, while a few use a physician forecasting model. Summary of the Innovation: One consequence of this disjointed approach was that Atlantic medical students have expressed as their top concern the limited access to data on the current and projected physician workforce. To address this issue, the Health Human Resource Task Force (formerly Atlantic Task Force) of the Canadian Federation of Medical Students created a national interactive platform that uses a map of Canada to illustrate the demand for physicians in our society. Users can filter data by specialty, province or territory (and regions), year, and source of the most relevant public data on the physician workforce. Conclusion: We believe that informing medical students with these realities during pre-clerkship will guide them to choose a career based on both personal interests and social accountability. Our group has also identified collaboration, social accountability, and artificial intelligence as the three fundamentals to modernise PRP strategy. Overall, these efforts contribute to the vision of system stewardship for an integrated Canadian health care system., Background/Purpose: People who inject drugs (PWID) represent a complex population for trainees. Despite increasing attention to PWID in the context of the opioid epidemic, there is a dearth of research exploring how care for PWID is enacted within clinical training. Moreover, existing research does not address how both human and non-human elements shape the care and learning experiences relating to PWID. This study therefore aimed to explore the involvement of trainees in the care of PWID. Methods: Data collection and analysis was informed by Actor Network Theory with an emphasis on the symmetrical relationship between human and non-human actors such as policy and physical space. Data consisted of observational field notes, field interviews and artifacts from 100 hours spent on inpatient wards and emergency departments within two hospitals in an urban setting in Ontario, Canada. Results: Care for PWID is enacted quite differently compared to other patient populations. Resource constraints and variation in how polices are enacted assemble with challenges such as frequent physical absences of patients to produce 1) mistrust between patients and staff; 2) suboptimal withdrawal management, and 3) PWID leaving against medical advice. For trainees, misalignment between PWID and staff, and poor outcomes contributed to frustration and futility. Conclusion: Trainees play an increasingly important role in the care of PWID. Continuing with the status quo risks training a population of physicians whose experiences of “learned helplessness” hinder their ability to advocate and care for this vulnerable patient population., Background/Purpose: Healthcare professions have the lowest representation of workers with disabilities compared to any other Canadian workforce sector. Health education is the gate to working in health professions, and therefore promoting inclusiveness in health education is essential to diversify healthcare professions. In Grassroots theory for social change, it is believed that groups of people can create power by taking mutual action to achieve social change. According to this theoretical framework, advocacy should be focused on working with many, to build a community that will work together toward a mutual goal. We used this framework to impact policies that affect people with disabilities in health education. Summary of the Innovation: Rich data from a qualitative study, wherein we heard the lived experiences of students and clinicians with disabilities in healthcare professions, led to a knowledge dissemination project, called Inclusive Space network. We created knowledge translation materials as well as a campaign to reach students, faculty, and curriculum developers in health education, and the general public. We will also present the process of building the advocacy network among students and faculty in the healthcare professional programs, and describe the responses of the healthcare education community to the campaign. Conclusion: The Inclusive Space Campaign was found to be a very useful educational tool for increasing awareness of the experiences of students and clinicians with disabilities in healthcare professions. Initiatives like these that involve multiple stakeholders are much needed to increase inclusion and equity in healthcare education., Background/Purpose: Competency frameworks identify Health Advocacy (HA) as critical in physician practice, though its exact meaning remains contentious. Little has been done to examine how learners understand their HA role. Our study asked learners how they understand HA in their diverse educational and practice contexts. Methods: Using constructivist grounded theory, we purposively sampled medical students (N=80) and family medicine residents (N=48) from diverse educational and practice contexts. We analyzed existing written reflections, then completed individual and group interviews with theoretically sampled participants (N=29), including new participants from pediatric (N=2) and internal medicine (N=4). Results: We found that learners understood HA in two distinct ways: 1) As identifiable behaviours, applied across contexts. 2) As “going above and beyond” what would be expected in that context, for their patient(s). These two approaches to HA often came into conflict as learners struggled to articulate their role as health advocates; the first approach suggests that HA is a normative set of behaviours that all physicians should be able to perform, regardless of context, while the second suggests a sense of pushing past normative expectations in a particular context by “going above and beyond.” Conclusion: These conflicting definitions can be troubling to learners who struggle to achieve “competence” by the time they complete their training. However, in our view, both approaches have value. Behavioural conceptions of HA offer a benchmark for teaching and assessment while “going above and beyond” invites learners to identify and push the boundaries of current practice in order to improve care in imperfect systems., Background/Purpose: Homelessness is one of the most powerful social determinants of health. Patients who have a history of homelessness, particularly those who also have a diagnosis of mental illness, often do not seek out medical care due to perceived stigma and barriers to empathy. However, it remains difficult for medical faculty to effectively teach compassion regarding this topic to medical students through didactic learning. Summary of the Innovation: This innovation involved pre-clerkship students and community members with lived experience of homelessness and mental illness. The community members were recruited from our partner organization Houselink, a Toronto-based community housing agency and non-profit organization with a focus on mental health. Pre-clerkship students were matched with a community member from Houselink. On a biweekly basis for two months, written correspondence was exchanged. All written correspondence was anonymized, without any identifying data. After the two months of piloting the innovation, feedback from participants will help inform broader curriculum implementation. Conclusion: This innovation is beneficial for both the medical student and community member groups. Medical students were able to interactively learn about social determinants of health, by connecting their knowledge of health with a local story. Furthermore, community members were able to share their experiences, which often goes unheard and under-acknowledged. This longitudinal innovation aimed to create meaningful partnerships for both parties, since community members at Houselink previously reported feeling isolated. This pilot innovation was inexpensive and time-effective, and has the potential to be scaled to be implemented in the undergraduate medical curriculum at the University of Toronto., Background/Purpose: Physicians are in a powerful position to improve the health status of oppressed peoples by working to mitigate disparities rooted in social and structural inequities. However, it is uncertain whether medical schools are adequately equipping future physicians with the skills needed to care for diverse people and bodies, beyond the theoretical considerations of the social determinants of health (SDoH). The current scoping review aimed to describe how Canadian medical schools teach social justice, comparing pedagogical strategies. Methods: An electronic search was performed using OVID to identify published studies of social justice-based interventions that authors implemented and evaluated within Canadian medical school curricula. Results: Six studies met inclusion criteria - two focused on experiential learning, two described didactic methods, and two interventions were mixed. Common outcomes identified by the studies included increased content knowledge, greater understanding of SDoH, acknowledgement of power and privilege imbalances, identification of physicians' roles as advocates, emphasis on the importance of interdisciplinary care, and increased capacity for self-reflection and personal growth. Experiential interventions were associated with greater personal transformation, but tended to have limited accessibility. Conclusion: Despite the widespread recognition of physicians' roles as health advocates, there is a lack of consensus about the most effective strategy for teaching social justice in medical education in Canada. While additional research focusing on the relative merits of didactic versus experiential learning is needed, these preliminary results suggest that experiential learning emphasizing self-reflection and personal growth may be the optimal approach towards transformative learning., Background: The substantial number of Canadian medical graduates (CMGs) failing to secure post-graduate residency positions through the Canadian Residency Matching System (CaRMS) is a well-known problem. No study to date has examined residency program director (PD) perspectives on why CMGs fail to match and how PDs perceive previously unmatched applicants. Methods: We conducted a pilot study at our institution with PDs representing programs participating in the CaRMS R-1 match. Seven of the 28 contacted PDs were interviewed. Interview transcripts were independently coded in NVivo 12.2.0 and themes were reached by consensus. Results: Most study participants were PDs with at least 2 years' experience representing small to moderate sized programs. Five programs were procedural specialties. PDs identified concerns about fairness to other applicants and risk of student litigation with providing applicants advice but overall felt comfortable meeting with unmatched CMGs. PDs were sympathetic towards unmatched CMGs and felt CMGs may not match due to professionalism or other application “red flags;” too few applications or applications to overly competitive programs; or weak interview skills. PDs felt being unmatched is unlikely to negatively affect future applications to their programs. Most PDs were unaware of opportunities available to unmatched CMGs provided by our institution. PDs recommended unmatched students consider additional research and clinical experience to strengthen future applications. Conclusion: Our study provides a first look into how PDs view unmatched CMGs. PDs identified match factors beyond “red flags,” such as professionalism. Education for PDs on opportunities available to unmatched CMGs and challenges facing unmatched CMGs may be beneficial., Background/Purpose: Currently career advisors for undergraduate medical students can only provide general advice and support for residency application, as there is limited data to support detailed application strategies. This study utilizes a large registry of longitudinal data from the Canadian Resident Matching Service (CaRMS) and examines factors that influence students' matching outcomes. Methods: We analyzed matching outcomes based on seven years (2013-2019) of residency application data (n = 13,499) from the CaRMS database using descriptive and binary logistic regression modeling techniques. Results: Applicants who received higher number of rankings are more likely (OR = 1.185, p < 0.001) to match to their first choice discipline in the first iteration of the match regardless of discipline competiveness. Graduation from a medical school in Quebec (OR = 0.481, p < 0.001), number of applications submitted (OR = 0.920, p < 0.001), and research activities (OR = 0.985, p < 0.001) had reductive effects on matching outcomes. Publication outputs (OR = 1.001, p > 0.05) did not significantly predict matching outcomes. Conclusion: The number of rankings an applicant received emerged as the only consistent and robust predictor of achieving successful matching outcomes. This information can guide career advisors in supporting medical students in their CaRMS application strategies, and inform residency programs' application and selection processes., Background/Purpose: Three to twelve percent of medical residents require specific support to successfully complete their residency. There is no literature on the perspective of remediated residents about their experience. The study intends to help fill the gap and to contribute to remediation knowledge in medical residencies Methods: Qualitative study using interpretative phenomenological analysis of 6 semi-structured interviews of practicing family physicians who underwent successful remediation. Results: Super themes found: pre-remediation unawareness of deficiencies; pre-existing mental health issues, presence of financial, cultural, gender, age, religious, familial, hierarchical, legal and identity issues at play. Remediation usually useful; could seldom be damaging in the short or long term. Remediation success related to a resident-centered design, with customized tutoring and coaching on consensual specific deficiencies. Supportive attitude of staff was an important feature related to success. Wellness, psychological and peer-support groups could contribute, according to profile. Unanticipated negative impacts found on licensing, early career trajectory, access to academic career and possibly on resident health. Unexpected positive impact of the research interview process for participants. Former residents suggested earlier feedback of trainee's clinical deficiencies and emotional issues, better continuity between remediation and general residency program and creation of neutral review of the remediation decision Conclusion: Insights of former trainees can be useful in designing and evaluating residencies remediation programs., Background/Purpose: The Canadian residency application process includes exploring specialties of interest through medical electives and applying and interviewing for those specialties. Given the considerable amount of debt incurred by medical students throughout their training, this process comes as an added financial requirement. This study assessed the reported costs of this process and gathered students' perspectives on the process. Methods: An online survey was distributed to graduating class medical students across Canada in 2018 and 2019. The survey gathered quantitative data including demographic and expense data (elective rotations and interview costs), and qualitative data on students' perspectives. Results:245 students from 12 medical schools completed the survey from March 2018 to May 2019. Students spent between 340$ and 25 000$ on their process (median 2818$, average 3957$). Several factors influenced the cost of the process such as the desired specialty and the location of the base university - with francophone-university graduates spending less than their peers. Overall, 63% of students believed the cost of the application process was not reasonable and 61% would favor a centralized interview process. Narrative comments revealed 35% of students view administrative fees as significantly burdensome and 12% viewed the process as unequitable or unescapable. Conclusion: The cost of application to residency varies tremendously from student to student due to a variety of factors but most students believed the cost of the process was not reasonable and would favor a centralized interview process. Amongst other areas, administrative fees were highlighted as a potential target to reduce costs for future applicants., Background/Purpose: Anticipatory stress (AS) arises from a (perceived) lack of control about future events. Research on AS has mostly examined physiological indicators such as salivary cortisol or blood pressure. The exploration of AS in residents also remains unexamined. Nearly one in five newly graduated physicians cannot find a full-time job in Canada. The objective of this study was to explore the construct of AS related to residents finding a job after completion of their postgraduate training. Methods: Medical students, residents, and former program directors were recruited via purposive sampling. Semi-structured interviews probed for factors that lead to stress associated with residents finding a job after residency, defining AS and whether participants experience(d) stressors associated with finding employment after residency. Interviews were audio-recorded and transcribed verbatim. Two reviewers independently coded the interview transcripts using thematic analysis. Results: N=21 interviews were conducted (n=6 medical students, n = 9 resident physicians and n= 6 former program directors). Common themes that arose with respect to AS were: lack of job market information, the learning environment, willingness to relocate, financial and family situation, level of independence, connections with staff physicians, specialty selection and the need for additional training. There was consensus around AS changing with respect to where on the continuum of learning and practice, participants were situated. Conclusion: Anticipatory stress can be experienced with respect to finding a job after residency. Transparent career development initiatives to help residents find a job after residency along with job market data surveillance and reporting warrant further investigation to ensure learner needs are met., Background/Purpose: In 2009, a family medicine (FM) residency program at a large Canadian university transitioned to competency-based medical education (CBME). The objective of this study was to investigate the relationship between motivation, specifically achievement goals, of FM residents trained in CBME and their performance on the in-training examination (ITE). Methods: This was a longitudinal, cohort study. Residents' achievement goals (performance-approach, performance-avoidance, and mastery-approach goals) were assessed at the midpoint of the two-year residency training. The ITE, a low-stakes formative assessment, was used to measure residents' knowledge in family medicine in Years 1 and 2 of residency training. Descriptive and regression analyses were performed. A total of 45 (52%) residents had complete data at three points of data collection. Results: In clinical settings, residents predominantly endorsed mastery-approach goals, which is the most adaptive form of motivation linked to deeper learning. However, regression analysis revealed a significant negative effect of these goals on residents' performance on the ITE in Year 2 (beta = -0.29; p < 0.01), after controlling for their Year 1 ITE performance. Performance goals (less adaptive forms of motivation) had no significant effects on residents' performance on the ITE. Conclusion: Although FM residents trained in CBME appeared to focus on mastery (as opposed to demonstration) of competencies in clinical settings, these goals, surprisingly, were not linked to improved performance on the in-training examination. Implications of this finding for practice in medical education will be shared with the audience., Background/Purpose: Youth from rural communities face significant challenges in the pursuit of healthcare training. Healthcare trainees with a rural background are more likely than those without to practice rurally as healthcare professionals. Summary of the Innovation: The Healthcare Travelling Roadshow (HCTRS) is an initiative that provides rural youth with exposure to healthcare careers, while providing healthcare students with exposure to rural opportunities, and an interprofessional education experience. To our knowledge, this is the first description of an initiative for rural university-high school healthcare career outreach that involves near-peer teaching, highly interactive sessions, and an interprofessional focus. Ten HCTRSs took place throughout northern, rural and remote British Columbia between 2010 and 2017. Conclusion: Questionnaires were delivered to youth, healthcare students and community members. Quantitative elements were graded on a 5-point Likert scale. Qualitative elements were analyzed thematically. Participants indicated that the program was very successful (4.71, 95% CI 4.63-4.79), would likely encourage healthcare students to consider rural practice (4.12, 95% CI 3.98-4.26), and that it inspired local youth to consider careers in healthcare much or very much (4.45, 95% CI 4.35-4.55). Qualitative analysis led to description of four themes: 1) Sincerity and interactivity sparking enthusiasm; 2) Learning through rural exposure and community engagement; 3) Healthcare student personal growth; and 4) Interprofessional collaboration and development. Constructive comments emphasized that meeting the needs of all stakeholders requires a degree of compromise. Success of the program requires meaningful engagement with multiple academic and community stakeholders., Background/Purpose: Existing literature highlights attributes of successful physician mentorship programs. However, limited research explores women's experiences as a rural physician, and gender-related pressures. This study aims to investigate the role of a formal mentoring program in supporting female rural physicians in their development of successful mentoring relationships. Summary of the Innovation: To date, 110 physicians practicing in rural British Columbia have been enrolled in a formal eight to ten month mentoring program developed by UBC CPD. Mentors and mentees participated in post-program activities in which they reflected on their experiences with the program and its impact on relationship-building, personal and professional satisfaction, as well as integration in rural BC. Surveys have been analyzed using thematic analysis and phenomenology. 53 mentees completed the survey. Three themes emerged from surveys amongst female mentees: demands of having a young family, maintaining work-life balance, and gendered mentor preferences. Female mentees were twice as likely to specify preference for a female mentor in comparison to male mentees preferring a male mentor. Female mentees were 3.5 times more likely than men to request support from a mentor with a married family status, and female mentees were 5 times more likely than men to request a mentor who could specifically assist them in maintaining work-life balance. Conclusion: Rural physician mentorship programs that acknowledge gender-based challenges can improve and create solidarity amongst rural female physicians. Our findings will inform the design of future mentorship programs and initiatives responding to the unique needs of rural physicians., Background/Purpose: Rural physicians have intimate patient-provider relationships which afford them a window into community context and patient needs. This awareness positions them with a valuable perspective to conduct socially accountable research that addresses contextually specific health needs within their communities. Memorial University has introduced the 6for6 program to empower its rural medical faculty to overcome the barriers typical to rural scholarship (e.g., lack of skills, geographical and professional isolation) and enable them to research solutions to community-specific health needs. Summary of the Innovation: 6for6 is a research-focused longitudinal faculty development program. We deliver a blended synchronous and asynchronous curriculum to six rural faculty over six sessions in a year, covering research and writing fundamentals. Transcending the curriculum is a socially accountable commitment on behalf of the program to empower participants to construct a research project around a healthcare issue from their community. We achieve this empowerment through regular peer-to-peer review, individualized mentorship, and dedicated support from a shared research assistant. The ultimate goal is for participants to graduate with the knowledge and skills required to conduct a well-defined, socially accountable research project aimed at uncovering solutions to a local health issue. Conclusion:6for6 has empowered thirty rural physicians across its 5-years of delivery, working on projects ranging from Indigenous maternal health to physician resilience. Resulting participant research has influenced strategic plans in regional health, lowered emergency department wait times, and educated many small-town community citizens about well-water contamination. When empowered, rural medical faculty can conduct and inspire impactful, socially accountable research., Background/Purpose: The lack of a unified national physician licensure in Canada restricts physician mobility and negatively impacts patient care. Currently, working in a different province/territory requires a separate medical license for each of the thirteen medical regulatory authorities, despite similarities in licensure processes and required documentation. These barriers limit the exposure of early career physicians including residents, while restricting access to physician care, especially in rural communities. Summary of the Innovation: Resident Doctors of Canada (RDoC) has been advocating for a unified licensure process through several avenues. Firstly, our 2018 national resident survey demonstrated that while only 18.5% of residents plan to locum outside the province/territory of their primary practice, 52% would pursue locum experiences if no additional license applications were required. Secondly, RDoC published a Collaborative Statement on Canadian Portable Locum Licensure in 2017, with the support of national organizations. Thirdly, RDoC has advocated for improved physician mobility, and are supportive of the Fast Track and License Portability Agreements in development by the Federation of Medical Regulatory Authorities of Canada. However, these preliminary agreements do not include residents, as they require a license for independent practice. Conclusion: Our national survey identified residents' desires to practice in jurisdictions outside their primary province/territory. National processes to facilitate a unified or fast-track licensure would enrich resident education by facilitating exposure to diverse practice settings and would help address healthcare needs in underserved communities by encouraging resident mobility., Background/Purpose: Palliative care practice is complex and challenging. This is amplified in rural settings with limited specialized services, high burden of care, broad scopes of practice, and relationships entangled across personal-professional boundaries. The purpose of this study was to gain a deeper understanding of palliative care learning for providers in low resourced rural environments in order to improve education and support for future rural healthcare providers. Methods: Narrative inquiry informed approaches to data collection and analysis. Data was collected through semi-structured interviews and rich pictures, a visual research method that uses participant-generated drawings to both evoke and record insights into complex situations. Participants included physicians (n= 9) and nurses (n= 6) practicing in rural northern Ontario. Results: Participants drew and recounted vivid and emotional stories. They described the process of rich pictures as enlightening. Positive and negative emotions were elicited in the narratives. Participants described tensions between feeling powerful and acting with autonomy and feeling compromised or constrained in actions and feelings. Narratives and drawings tended to capture the impossibility of perfection and the physical, emotional, and moral complexity that one encounters when providing palliative care. Most participants noted that their formal education did not prepare them for the reality of rural palliative care practice. Conclusion: Findings revealed memorable palliative care learning as fleeting opportunities that must be seized and reflected upon by healthcare providers and not something that can necessarily be planned. Conceptualizing learning as a process of becoming can be a useful framework to prepare and support current and future rural practitioners., Background/Purpose: The mission of Distributed Learning and Rural Initiatives (DLRI), University of Calgary, is to facilitate relationships between “medical educators, healthcare professionals in training, and individuals and families living in rural communities.” The current study evaluates the DLRI website to determine whether it accurately reflects our mission and commitment to rural medicine. Methods: We examined all public-facing webpages that comprise the DLRI website. Text were analyzed for both purpose and content. We also conducted a visual analysis of images on the webpages using techniques derived from art criticism. Specific attention was paid to the subject and context of the images as well as any notable presences or absences. Results: Thirty-two webpages were analyzed. DLRI's mission was only described explicitly on one webpage. Text on many webpages were procedural with substantial use of jargon. Student pages, in particular, were very directive and often used negative phrases. The visual analysis found that of 23 individual images, 14 of them were rural landscapes with no people. The majority of images containing people showed students, often depicted socializing. Little ethnic diversity was seen in images. Conclusion: Textual analysis of the DLRI webpages indicates a mixture of welcoming and bureaucratic discourse. The visual analysis of the images documented a focus on isolated, de-populated rural landscapes. In addition, there was a notable absence of images of patients, community members, or individuals from diverse backgrounds. The analysis informed recommendations to align the text and images with the DLRI mission and the social accountability mandate of the University of Calgary., Background/Purpose: Preparation for ethical decision making in practice can be challenging for postgraduate (PG) trainees. Strategies from learning science on integration of ethical and clinical reasoning to promote transfer of learning may enhance ethics education. We report the evaluation of a curriculum based on learning science principles for teaching ethics to family medicine (FM) trainees at the University of Toronto. Methods: A longitudinal curriculum was deployed as a pilot at 4 training sites over two years to FM PG trainees. A rich description of the curriculum is presented as an innovation report. A comparative evaluation focused on a) evidence of changes in ethical reasoning and b) performance on simulated scenarios requiring ethical decision making. Evidence for a) was gathered through interviews of trainees about ethical challenges in clinics in the curriculum sites and control sites; b) through a 5-station OSCE blueprinted on exit level ethics competency and scored by blinded raters. Results: A total of 12 interviews with curriculum and control residents were completed will be reported. Twelve curriculum and 9 control trainees in final year of training participated in the OSCE. A large effect was seen in favour of curriculum trainees (Cohen's d =1.01, F(1,19)=5.3,p, Background/Purpose: Research in education is essential to advance knowledge as well as to improve learning. Medical residents can be solicited as subjects for studies, however no literature defines how to protect their rights as participants and to limit the impact of their participation on their clinical training. Methods: Through a modified Delphi study, a group of 8 experts in Pediatrics at Université de Montréal, (clinical educators, education researchers, residents and IRB president) developed recommendations to guide how the inclusion of residents as subjects in medical education research can take place with the dual goal of protecting residents' rights while also promoting contribution of researchers' work to medical education literature. Results: Five issues and recommendations were described. 1) Freedom of participation: participation or non-participation, or withdrawal from a study should not interfere with teacher-learner relationship (recommendations on procedures for recruitment and content of consent form) ; 2) Over-solicitation of residents (recommendations on the process of limiting the number of ongoing studies); 3) Management of time dedicated to participation to research (recommendations on schedule and proportion of time for study participation); 4) Educational security: data collected during a study should not influence clinical assessment of the resident (recommendations on the role of the researcher as a clinical supervisor); and 5) Emotional security of the learner (recommendation on the requirement for debriefing during simulation-based studies). Conclusion: This guide is an essential tool to insure respect of resident rights and completion of a robust training program but also to support high quality research in education that will enrich medical education literature., Background/Purpose: Though by now well accepted in medical humanities, the use of literature for health care teaching has tended to remain narrowly circumscribed to the Anglo-American canon, limiting the usefulness of the literary texts for other linguistic and cultural groups of practitioners and patients. This innovation expands the canon to include the use of Western Canadian Francophone Literature in a model interweaving humanism into clinical teaching (bedside, “couch-side”, and seminar) in medicine and psychiatry, to resonate with non-Anglophones, while including universals that speak to all. Summary of Innovation: The model consists of suggested texts, guidelines to key concepts (representations of illness experiences, health care, and the impacts on family and community, narrative strategies), and recommendations for incorporating them into clinical training settings. For example, the juxtaposition, in a clinical seminar, of two short story collections, Un jardin au bout du monde (Garden in the Wind) (1975) by Manitoban Gabrielle Roy, and C'était écrit (It was Written) (2009) by Mauritian immigrant to Alberta, Eileen Lohka, reveals the health experiences of different generations of Westerners of diverse backgrounds, showing the impact of lives in historical context on the expression of illness, individually and impacting the local and broader communities. Conclusion: This innovation builds on successful models from previous research and teaching practices (undergraduate, post-graduate, continuing medical education), both personal by the author, and by leading scholar-clinicians in the field of narrative medicine, like Rita Charon. Such interventions have been shown to have positive effects on a physician's professional activities, benefitting both caregiver and patient., Background/Purpose: Learning experiences that integrate arts and humanities (A&H) within curricula may lead to important learning outcomes, including skills-based outcomes such as honing observation and interpretation skills, relational outcomes such as empathy, communication, and teamwork, and transformational outcomes related to professional identity and advocacy. The range of A&H that can inform medical learning and, ultimately, patient care is vast. We conducted a scoping review to identify how and why the A&H are being used to educate physicians and interprofessional learners across the developmental spectrum. Methods: A search strategy involving seven databases located 21,684 citations. Five reviewers independently screened titles and abstracts. Full-text screening followed (n=4,348). Of these, 653 met inclusion criteria. We performed demographic, conceptual and discursive analyses. Results: The literature is diverse and dominated by (a) conceptual works that call for the use of A&H in medical education generally or that critically engage with its ideas and methods, and (b) qualitative studies that evaluate A&H-based pedagogical strategies, notably the use of literature and reflective writing. Conceptual analysis demonstrated that A&H function as a means for learners to master skills and engage in perspective-taking and relationship building. In the discursive analysis, the relationship between the A&H and medicine is often constructed as a way to supplement medicine with new perspectives and knowledge. Absent are the voices of medical students and artist- and community-based educators, as well as robust engagement with A&H in pre-medical and continuing medical education. Conclusion: These results can inform national and institutional discussions regarding the use of A&H in medical education., Background/Purpose: Temporality, occupation, and relationships are identified as discrete factors impacting quality of life for patients at the end of life (EoL) and their loved-ones. However, educators and practitioners require insight regarding whether their interaction shapes quality of life for patients at end of life. This study is framed by an understanding that meaning is negotiated between people through social interaction and occupational engagement in temporal contexts. Methods: We conducted in-depth interviews with 9 patients and 10 loved-ones followed by an iterative analysis process involving open, axial, and selective coding. Results: The data highlight ways that temporality impacts relational and occupational experiences. We explore this within three main processes: 1) experiences of temporal rupture, 2) diminished significance of clock time, and 3) shifts in occupational priorities focused on being, becoming and belonging. Conclusion: Our analysis of participant narratives provides novel insights into the complex interactions between temporal, occupational, and relational aspects that patients and their loved-ones experience in hospice. Health professionals can enable better EoL experiences by acting upon their awareness of these complexities. It is critical that educational practices prepare health professionals to understand how patients and loved-ones experience quality of life - including altered temporality and shifting priorities - if we are to foster patient-centered EoL care., Background/Purpose: Medical assistance in dying (MAID) became legal across Canada when Bill C-14 was passed in 2016. Currently, little is known about practitioner interest in MAID education, the most effective strategies for providing MAID education, and the importance of integrating MAID into existing curricula. This study examines and compares residents' and faculty preceptors' perspectives about MAID. Methods: Two anonymous surveys were distributed to residents (n=549) and preceptors (n=797) in 29 different specialty programs. Survey data was analyzed using descriptive and inferential statistics. Results: Response rates were 23.1% for residents and 13.0% for preceptors. Preceptors were more comfortable and competent discussing MAID with a patient compared to residents (p, Imagery connects with people on an emotional level. This is especially true for a topic as stigmatized as substance use. If the style or content of an image clashes with the tone of the educational work, it can polarize the learner, and cause them to lose trust in the content. To ensure the use of comics did not distract from learning, we developed a process for using original comic art to compliment addiction care and substance use education. Designed in partnership with BCCSU, the Addiction Care and Treatment Online Course provides self-paced education for health care providers to diagnose and treat patients with substance use disorders. To make content more engaging, we developed a unique visual style for the course. Comics helped describe specifics substances, add realism to case studies, personalize characters, and enhance text throughout the course. Visuals were designed and refined along with text content. Input was gathered from subject matter experts and staff on visual accuracy, interpretation, and tone. Comics are often associated with humor and fiction but with careful consideration they can communicate complex topics, compliment text-based education, and improve learning outcomes as described by dual processing theory. We discovered that early implementation of art in content creation was critical. Rather than final touches, the visuals were key in the iterative process. The module launched February 2019. As of September 2019, over 5,500 learners have enrolled. Learner feedback collected through post-course surveys indicate the visuals are enhancing and not distracting from learning., Theatre offers a powerful medium to promote perspective-taking, emotional identification, and assimilation of new information about marginalized groups in an experiential way. Therefore, Research-Based Theatre (RBT) can increase knowledge, deepen understanding, and impact attitudes among students who are studying to become health professionals. This project used RBT as an educational tool to facilitate discussion around disability, and measured its impact on attitude change and knowledge increase regarding the issues faced by students and clinicians with disabilities in health professions. Method: Alone in the Ring, a 30-minute play based on interviews we conducted with 80 students and clinicians with disabilities, displays their stories and experiences. Students and faculty watched the play and participated in a discussion following the play. Attitude toward and knowledge about the experiences of students and clinicians with disabilities was measured before and after the play. Focus groups with some participants were conducted 2-3 weeks after the performance. Results indicated a shift in attitudes and increased knowledge of the barriers students and clinicians with disabilities face. Within this presentation we will describe how RBT can be used as an innovative educational tool in health professions education and practice to facilitate discussion on sensitive and complex topics and provoke new questions around accessibility and diversity in the professions. We will discuss issues related to ethical, educational, and professional dilemmas. This innovative educational approach to promote social change, inclusion, and equity for people with disabilities is meant to catalyze much needed discussions in health education., Background/Purpose: Research has acknowledged the value of patients as an essential stakeholder group in education, yet medicine has failed to incorporate patients' perspectives into a discourse they are surely expert in: professionalism. Our purpose was to explore patients' perceptions of professional behaviour in medical learners as a first step to considering patients' potential roles in assessing professionalism. Methods: Using a constructivist grounded theory approach we interviewed 12 patients (6F, 6M), recruited from one urban hospital. Each participant watched 5 video scenarios that depict common professionally challenging situations faced by medical students. After each video, participants were asked what they thought the student should (or shouldn't) do in the scenario, along with their rationale. Results: Participants' responses largely echoed those of medical students and faculty. They referenced principles of professionalism, the student's affect or internal factors, and potential implications of actions when discussing what they felt was correct behaviour. Patients conveyed an understanding of the multiple competing factors students must balance (e.g., providing optimal care while maximizing educational opportunities) and expressed empathy regarding some of the pressures students face. Participants also identified principles not previously raised by students or faculty, including the importance of respecting privacy and of not showing disagreement among professionals in front of a patient. Conclusion: Knowing what patients perceive as important will allow educational and assessment efforts to be refined to reflect their values. Our work can inform emerging initiatives to include patients in the assessment of medical learners., Background/Purpose: Learning science is an interdisciplinary approach that marries computer science, educational psychology and other fields to enhance the design of and solutions for teaching and learning. Specifically, the learning analytics process model provides a guide to design and implement learning dashboards aimed to improve learning. The purpose of our study is to demonstrate how we applied this model in three applications to improve the learning environments in medical education. Summary of the Innovation: We developed our own data reporting structure to provide oversight in clinical experiences and applied it in three different contexts. The first application was originally developed to track the completion of observed history taking and physical exam in the medical school. Through minor modification, the same dashboard was then used to track all clinical codes and experiences for clinical dental education. The third instance was modified to track the collection of entrustable professional activities across all residency programs. Through these applications of learning sciences, in data and cognitive domains, it improved the feedback and experiences students receive in clinical settings. Conclusion: The monitoring of history and physical exams has improved the consistency of supervision (>80%) in medical student clinical training for the past five years. Using the same dashboard for dentistry has led to a 30% increase year-to year in the quantity and categories of clinical experience. The use of this dashboard supported a soft launch of our Internal Medicine residency program two years before the national launch facilitating a smooth transition. This study demonstrates how one solution from learning sciences can be applied to improve learning experiences across three domains., Background/Purpose: South-Western Ontario (SWO) continues to face challenges recruiting healthcare professionals, particularly to rural sites. In order to combat this, healthcare careers can be promoted among highschool students in SWO, as they are still in the midst of deciding on their future career, with the intention of them returning to their community. These objectives were executed through Discovery Healthcare (DHC); a summer camp aimed to expose highschool students in SWO to a broad spectrum of healthcare careers to promote interest in these fields and retention in their communities. Summary of the Innovation: Five-day long camps were held in Leamington, Sarnia, Chatham-Kent and Wingham throughout July 2019 facilitated by four medical students. There was a total of 77 students with the majority going into grades 9 and 10. Students heard from local guest speakers in fields such as medicine, nursing, and allied health. Some spent an afternoon shadowing healthcare professionals in community hospitals, and did an ambulance tour with a paramedic. They had the chance to learn clinical skills such as vitals, casting, and suturing. Students also worked through case diagnoses and learned about social determinants of health. Conclusion: Surveys were distributed to students at the beginning and end of each camp in order to gauge their understanding of pathways to different healthcare careers, and their interest in pursuing them. After the camp, they had a greater understanding, but an increase in interest depended on local availability of speakers. They were also interested in additional careers that they had not previously considered. DHC aspires to further its impact by inspiring more highschool students in SWO to pursue healthcare careers. We hope that this initiative will launch similar programs in other underserved areas., Background/Purpose: Health disparities between Indigenous and non-Indigenous Canadians may be perpetuated by inadequate training of medical professionals on Indigenous topics including the colonial history of Canada with longstanding systematic mistreatment of Indigenous Peoples. The purpose of this review is to analyze the current state of Indigenous Health (IH) curricula in Canadian medical schools. Methods: Literature search was conducted using OVID database, news media, medical school websites, and IH medical education resources. Publications were screened for relevance and reliability. Data was analyzed using thematic analysis. Results: Out of 125 documents identified through the search, 28 were selected for full text review. Publications were classified into four themes: Current State of Canadian Medical Schools, Perception of Medical Students, Recommendations for Medical Schools, and Indigenous Voices. In response to the AFMC-IPAC recommendations from 2008, medical schools have made IH additions to curriculums by increasing participation of medical students in Indigenous health-related activities, enrolment of Indigenous medical students, and cultural diversity training. However, a lack of standardization was found with adhering to recommendations in medical schools across Canada. Medical students still report inadequate preparation for provision of healthcare for Indigenous persons and communities. Additionally, Indigenous communities continue to report discrimination and a lack of opportunities that provide meaningful input into curriculum. Conclusion: Although Canadian medical schools have made changes to IH education, recommendations have yet to be effectively incorporated into medical school curricula, especially suggestions from Indigenous communities. Based on the perceptions of students and Indigenous communities, further curricular reform is required to improve healthcare for Indigenous Peoples., Background/Purpose: Physician role modelling is an important means through which knowledge and skills transfer from clinician to trainee, helping to foster clinical expertise. However, day to day clinical practice is inherently complex and is characterized by wide variability. Practice variability may arise in situations of clinical uncertainty where there is a lack of clinical practice guidelines, or where more than one clinical approach is acceptable. Due to this considerable variability, learners face substantial challenges drawing guidance from more senior clinicians. To develop their own expertise, trainees are faced with the challenge of making sense of the variable and sometimes contradictory practice patterns of their clinical preceptors. The purpose of this study is to explore how learners make sense of the variation they see in clinical practice and how this variability influences their own practice patterns. Methods: This study drew from constructivist grounded theory methodology. Data was collected using individual semi-structured interviews, conducted at two Canadian academic tertiary care hospitals. Participants included senior trainees in medicine-based residency training programs and recent graduate physicians. Results: A model of learning emerged in which the concept of a personal style of medicine was central. Both trainees and recent graduate physicians described their own developing style of medicine playing a pivotal role both in how practice variability was interpreted, and which practice patterns were adopted. Clinical mentors, institutional practices, medical hierarchy, and peer practice also influenced how learners interpreted variable practice patterns and how they made decisions selecting their own practice patterns. Analysis is ongoing at the time of submission. Conclusion: Medical learners are confronted with wide variability in day-to-day practice. Clinical mentors, institutional culture, peer practice, and a sense of personal identify impact how learners perceive variation, and influence their decisions around adopting or rejecting particular practices. Improving our understanding of how learners decipher practice variation will add to our knowledge of how expertise is developed and will better enable us to help learners to move along the continuum from novice to expert., Background/Purpose: Depuis l'implantation de l'approche par compétences en formation médicale, divers établissements dans le monde implantent des outils pour évaluer le progrès et les niveaux de maîtrise des compétences. Ces outils sont souvent mal adaptés au contexte particulier de la médecine de famille. Notre présentation vise à décrire le processus d'élaboration collectif d'une Fiche d'appréciation du stage clinique (FASC) en médecine de famille. Cette fiche juxtapose les Activités professionnelles confiables (APC) et les compétences requises pour les réaliser. Summary of the Innovation: Un groupe de travail mandaté par la Direction du programme, avec les 18 Directeurs locaux de programme (DLP) a validé une liste d'APC par une enquête Delphi. Dans un deuxième temps, lors d'une journée d'atelier, 47 participants (enseignants et DLP) ont décrit les niveaux de maitrise attendu à observer chez les résidents pour chaque APC. Ces travaux ont mené à la création d'une nouvelle FASC et d'un Guide de notation qui permettent d'évaluer 11 APC et 7 compétences. L'appréciation des APC se base sur la confiance que suscite chez les des enseignants le travail des résidents. Cinq « niveaux de confiance dans la délégation de responsabilité » (NiCDeR) ont été définis pour les principales compétences sollicitées par chaque APC. Conclusion: Nous pensons que ce nouvel outil d'évaluation peut servir à tous les programme de médecine de famille visant une approche par compétence. L'utilisation d'un processus de co-construction a permis d'augmenter la validité et la pertinence de cette FASC et de favoriser son appropriation par les cliniciens-enseignants sur le terrain., Background/Purpose: Prescribing is an essential activity for physicians, requiring attention to detail and patient factors. In Canada, most prescriptions are printed or faxed to a pharmacy. In 2020 there will be approximately 811 million prescriptions dispensed in Canadian community pharmacies. e-Prescribing is the secure transmission of a prescription from an electronic medical record (EMR) to a pharmacy's computer system; key to this process is the use of data fields and standardized terminology. Canada Health Infoway is implementing PrescribeIT™ across Canada, a digital solution that will require training of medical students, residents and physicians. Research has shown that, while e-prescribing increases patient safety by improving legibility and reducing fraud/misuse of controlled substances, other types of errors may occur, requiring new types of vigilance and systems understanding. Summary of the Innovation: The Association of Faculties of Pharmacy of Canada (AFPC) has created an online, open access, competency-based, educational resource called e-Learning for Healthcare Professionals. An e-prescribing course was developed in collaboration with the Association of Faculties of Medicine of Canada and the Canadian Association of Schools of Nursing, funded by Infoway. Key concepts about e-prescribing are presented; learning activities include interactive virtual cases. The course can be used in both uniprofessional and interprofessional settings. A Fundamentals version for students requires about 90 minutes; a Comprehensive version is available for instructors. Conclusion: A tour of the course, with evaluation data from hundreds of pharmacy student users, lessons learned from faculty, and implementation strategies will be shared. The use of this course in this emerging and critical area by medical educators is encouraged., Background/Purpose: William Osler started the first journal club more than a century ago. Though technology has advanced, in our day as in Osler's, CME is challenging to deliver. This presentation discusses the Reading of the Week (ROTW), an innovative education project, aimed at Canadian residents of psychiatry, and the contribution of this project to residents' CPD. Summary of the Innovation: ROTW summarizes the latest literature and is emailed out weekly through formal partnerships with 12 Canadian post-graduate programs (roughly 90% of Canadian psychiatry residents); Readings are also available online. The selections cover everything from public policy to practice, including studies from the British Journal of Psychiatry and Lancet Psychiatry. Readings include commentary, providing a larger context. Like Osler's journal club, there is the opportunity to exchange ideas, with “letters to the editor.” In the spring of 2019, we aimed to assess outcomes for ROTW using continuing medical education (CME) evaluation framework (Moore's framework). Results: A total of 332 responded to the online survey (a third of subscribers). 90% reported they “always or usually” read the summary. 97% were satisfied with ROTW; 93% agreed that ROTW had improved their understanding of the current psychiatry research; 60% shared ROTW to someone else at least once. Comments included: “I have used the summaries to make better informed clinical decisions.” Conclusion: This presentation outlines the practical implementation and impact of a unique CME intervention aimed at addressing challenges related to remaining “up-to-date” amidst the vast amount of resources available in print and online. ROTW provides a boundless option for CME for trainees and providers., Background/Purpose: Online communication tools and platforms for peer and professional connections are widely adopted by students across health professional programs. Programs and professional standards, guidelines, and codes, emphasize the importance of using social media in a responsible and respectful manner which embodies professionalism. However, there are limited pedagogical tools and strategies to highlight the importance of making informed decisions about aligning digital identities with the expectations for health professionals. This project aimed at addressing that gap. Summary of the Innovation: Following a literature review and consultations with students and faculty clinicians, we developed authentic case studies with companion questions and resources for use in a “Digital Identity Workshop” for 224 first-year Doctor of Pharmacy students. A facilitator guide was also developed. All materials were made publicly available using a Creative Commons CC-BY license for reuse by other institutions. The Workshop engaged participants in discussions regarding privacy risks, exercising ownership over data distribution, the impact of ethically questionable behaviour on patient care, and the reputation of health professionals. The case studies, activities, and resources aimed to support students' confidence in aligning their emerging professional identities with their existing digital identity. Pre- and post-workshop assessments were deployed to measure students' ability to navigate this terrain. Conclusion: Faculty, staff, librarians, and students collaborated to develop, implement, and evaluate a digital identity workshop for pharmacy students. In this presentation we will share our innovation, experiences, and strategies to help support other health programs' efforts to enhance student development of professionalism in online platforms., Background/Purpose: Health professions education (HPE) programs continuously evaluate their quality to inform educational improvements and address accreditation demands. Having completed their education and had the opportunity to apply acquired competencies in their profession, new graduates are ideally positioned to provide feedback on their programs. However, response rates to exit surveys are generally poor, which have negative implications for the data quality, non-response bias, and overall validity. Recent studies suggest that 65% of adults engage in some form of social networking. We aimed to capitalize on the untapped potential of social media as a tool to increase survey responses among graduates of an Occupational Therapy Program. Summary of the Innovation: We identified characteristics of successful online postings and produced two videos featuring faculty discussing how student feedback is implemented with the overall message of 'pay it forward'. A reminder video featuring a graduate was also produced. The videos were posted over three weeks on Twitter, Instagram, and Facebook. Effectiveness of the innovation was measured primarily through the survey responses, which tripled from the previous administration. Social media analytics (e.g., conversation rate, responses to posts, likes, retweets, amplification rate) demonstrated that Facebook was the most effective medium. Semi-structured interviews with a subsample of the respondents revealed features of the video that were most effective (music, faculty, use of feedback). Conclusion: Social media is a powerful tool for increasing survey responses. The implementation of the innovation in this program may inform best methods to applying this approach across all HPE programs to augment survey responses., Background/Purpose: Residency program directors are required to gather evidence to make decisions about their program, to improve its effectiveness, and to inform decisions. Recent changes to the CanRAC accreditation standards include program evaluation. However, residency programs have diverse needs, and program directors (PDs) have limited time and varied knowledge of program evaluation. In response, we developed an innovative approach to support program evaluation in the over 70 different residency programs, using a scholarly and iterative process. This innovative approach included standardized templates delivered alongside capacity-building workshops. Summary of the Innovation: The innovative approach was implemented in two phases. Phase 1 included a capacity-building initiative for PDs as a one-day retreat. The retreat included three workshop activities using a stepwise approach to teaching principles of program evaluation, how to develop a logic model and evaluation matrix, and distributed logic model and evaluation matrix templates. Workshop activities integrated the CanRAC accreditation standards to provide PDs with concrete examples of how to use program evaluation to facilitate informed decisions on how to improve their residency program. Phase 2 included follow-up meetings with the education team members to review PD developed program evaluation plans. One-on-one support was offered to PDs once a month over the last year to assist PDs with the implementation of their program evaluation plans. Conclusion: This innovative approach provides standardized program evaluation templates for PDs to use in their program evaluation process, contributes to capacity building in PGME for program evaluation, and is a practical process, which can be implemented in PGME across Canada., Background/Purpose: The implementation of CBME is well underway in postgraduate medical education programs across Canada, which has produced opportunities for research and evaluation. Evaluation can be a prescriptive process; however, evidence suggests that involving relevant stakeholders and co-creating an evaluation plan may facilitate better engagement in the work required to shift to CBME. The purpose of this project was to create an inventory of CBME interests of program directors (PDs) from one Canadian university to build a scholarly network. Methods: Data from semi-structured interviews were analyzed using descriptive statistics, thematic analysis, and content analysis. Results:14 out of 24 (58%) program directors in the 2017 - 2019 CBME implementation cohorts participated in this project. Nine out of 14 (64%) PDs have specific interest areas for evaluation. Identifying residents in difficulty earlier, particularly for shorter programs (>2 years), was the most frequently identified interest followed by how much feedback is enough, and how to support faculty in the provision of quality narrative feedback that is documented. Other interests reported by PDs include the appropriateness of new assessments in developing a global impression of learners; how residents navigate assessment of learning (performance) versus assessment for learning (growth); and how residents cope and adapt with the shift in training model. Conclusion: The development of an inventory supported cross-specialty connections and collaboration on projects, directing resources and expertise to areas of interest and reducing unnecessary overlap. PD engagement in the evaluation process may promote the legitimacy of change and the value of participating in studies to better understand CBME., Background/Purpose: CanadiEM.org is a multi-author open access medical education website which aims to improve emergency care in Canada by building an online community for healthcare practitioners and providing them with high quality, freely available educational resources. Junior editors (medical student and/or resident) are key members of the community who are mentored to advance their academic skills and knowledge. The program also supports the sustainability of the CanadiEM project by supporting the creation and publishing of online content. We aimed to assess the impact and efficacy of this program while discovering ways to improve it. Methods: The experience of all current and previous Junior Editors were assessed through a survey of 48 questions, including 15 multiple choice rated using a Likert Scale, 10 open-ended, and 23 demographic or binary yes/no questions. The participants' perceptions of their experience, future involvement, and opinions regarding implementation at other websites were assessed using open-ended questions. These responses were thematically analyzed. Results: A total of 28 Junior Editors responded (71.7%). Results revealed a positive experience across all domains, with better experiences compared to previous similar roles. Most (85.7%) stated they achieved their expectations from the program, and 82.1% would incorporate this program into another medical education website if given the opportunity. Conclusion: Junior Editors placed particular value on digital and authorship skills development, inspiration for future FOAMed, research engagement, and mentorship/networking. Through collaboration, we will implement improvement initiatives. Based upon these results, we believe that the Junior Editor model may also be viable within other medical education communities., Background/Purpose: Underperformance in the professional role has high stakes for learners and educators. Problems with professionalism, unless appropriately and effectively remediated, may portend serious problems in practice. Yet, such remediation is particularly challenging. Increasingly, educators turn to reflective writing (RW) as a remediation strategy in residency, yet little is known about what educators expect RW to accomplish, how they choose RW tasks, why they use RW, or how RW is evaluated. In this study, we aimed to understand how and why postgraduate medical educators use RW as an educational intervention to remediate professionalism. Methods: We interviewed ten medical education professionals across eight Canadian medical schools. Data was analyzed iteratively for themes using coding principles from constructivist grounded theory. Results: We identified five dominant themes: (1) Professionalism is widely perceived as difficult to remediate, owing to lack of guidance regarding effective strategies and insufficient learner insight; (2) RW is part of multipronged yet variable approaches to remediating professionalism; (3) RW is expected to demonstrate or, less frequently, to help develop learner insight into the issue; (4) Standards for quality vary, and educators struggle with subjectivity in evaluating RW; and (5) Educators and learners are challenged by inexperience with RW and impacted by issues of learner vulnerability and confidentiality. Conclusion: This study represents an important step in medical education research towards apprehending how RW is used to navigate remediation around the professional role when challenges arise in residency. Understanding of the potential and pitfalls of RW may inform more tailored and effective approaches to professionalism remediation., Background/Purpose: There is a dearth of descriptions of wisdom in clinical medicine. It has often been conflated with proficiency in clinical reasoning and decision making. Given that clinical actions always involves an individual patient and an individual physician, their subjectivity and intersubjectivity, these concepts are inadequate in capturing the 'particularization' that is a cognitive necessity and a moral imperative of physicians in the context of patient care. Methods: Informed by a narrative review of the literature and a close reading of three preeminent texts, the authors reinterpret the phenomenon of wisdom in clinical medicine. Results: The Aristotelian notion of practical wisdom (phronēsis) offers a more coherent and complete account of wise medical conduct. A strategy of thinking about, with, and through clinical cases creates avenues for physicians to particularize the clinical encounter. Conclusion: Case based thinking in clinical practice includes understanding the unique features of a 'particular', reasoning about persons, constructing thick case descriptions, avoiding the hubris of premature case closure, and deliberating about right and good clinical decisions. This approach is authentically patient-centered and ensures the interweaving of humanism into medical practice and education., Background/Purpose: INCommunity internships were developed through medical students' motivation to understand the reality and challenges faced by neglected communities in Montreal. The project aims to equip physicians-in-training to holistically and empathically attend to their communities' health needs by acquiring cultural competence and knowledge on social determinants of health. Further, INCommunity focuses on fostering interprofessional learning through interactions with allied health professionals. Summary of the Innovation: INCommunity is a student-led IFMSA-Québec initiative founded in 2011. It consists of free 4-week summer observerships allowing medical trainees exposure to marginalized groups: migrants, indigenous communities, law offenders, neglected urban populations and women in states of vulnerability. The project partners with many placements sites: indigenous communities, clinics, NGOs, detention and youth centers, injection sites, rehabilitation centers and shelters. Upon selection, participants receive a compilation of articles and a training on cultural competency adapted to their stream. The internship itself includes various placements, weekly debriefing sessions among participants and one-on-one discussions with a mentor (physician). A reflective exercise is expected in the form of a report. Conclusion: With 68 students having been offered internships since 2016 and over 50 partnerships established annually, this student-led initiative was found to be an effective approach to teaching social determinants of health. Indeed, it was adopted as a week-long rotation in University of Montreal's clerkship curriculum in 2013. It is currently being implemented in Sherbrooke. Overall, INCommunity emphasizes the importance of collaborating with trainees in medical education to create better adapted and effective learning experiences., Background/Purpose: Women physicians are underrepresented in academia, leadership, and administration. Previous evidence suggests that women physicians are evaluated differently than men physicians; this manifests as lower teaching evaluation scores, student evaluation scores, grant attainment, and award distribution. While gender bias has been demonstrated at the level of academic and national research awards, awards selected by resident physicians have not previously been examined. Methods: A cross-sectional analysis of resident-selected awards for residents and staff physicians was conducted from 2000-2018 using data on award distribution from provincial and national residency organizations in Canada. Based on award name and/or description, we classified awards into either education and teaching awards or professionalism, advocacy and wellness awards. Results: Women residents and women staff physicians had significantly lower odds of receiving resident-selected awards than men (OR 0.57, 95% CI 0.39-0.81; p, Background/Purpose: On-line and didactic programs exist that aim to enhance cultural safety and trauma-informed care (CS&TIC). Most improve knowledge but may not adequately prepare participants to 'champion' service delivery and practice change. We designed the “CS&TIC Champions” workshop to equip self-selected service providers from the early intervention sector to apply knowledge translation (KT) theory and practice to support the implementation of CS&TIC best practices within their organizations across British Columbia. Summary of the Innovation: The one-day interactive Champions workshop the final component of a comprehensive curriculum co-developed by an advisory committee of Elders, service providers, educators and families with lived experience. We applied adult learning principles to introduce evidence-informed KT best practices and planning tools; participants engaged in group activities to set goals and applied these approaches in their respective contexts. Participants identified barriers to implementing CS&TIC, and actively generated solutions to these challenges. Immediately post-workshop, participants completed a survey gathering self-reported ratings of confidence (1=much poorer to 5=much stronger) and ability to perform KT activities to support practice change (1=poor to 5=competent). Conclusion: Twenty-two of 25 participants completed the survey. Respondents reported greater confidence as champions (median=4; IQR 3-4) and valued networking with other champions. They could identify KT strategies best suited for supporting CS&TIC in their contexts (median= 4/5; IQR 3-4), but more support was wanted to develop KT plans targeting barriers and facilitators. (median=3/5; IQR 3-4). The CS&TIC Champions workshop equipped participants with KT strategies, but follow-up coaching could better support participants to 'champion' translation of CS&TIC into service delivery and practice., Background/Purpose: Mettre en valeur la présence autochtone sur le territoire desservi par l'Université Laval et promouvoir l'échange et la collaboration entre les peuples autochtones et allochtones est un aspect de la responsabilité sociale de la Faculté de médecine. Summary of the Innovation: À cet égard, trois mini-écoles en sciences de la santé ont été organisées au cours de l'année 2018-2019. Ainsi, 700 élèves de niveaux primaire et secondaire des écoles des communautés innue de Pessamit et huronne-wendate de Wendake ont rencontré plus de 90 étudiants et étudiantes provenant d'une dizaine de programmes liés à la santé, dont la moitié en médecine. Les membres de tout âge de ces communautés ont aussi participé à l'accueil chaleureux lors d'une soirée où les échanges culturels étaient à l'honneur. Les liens créés visent à stimuler l'intérêt des jeunes pour des professions de la santé et ce faisant, à contrer le décrochage scolaire, tout en les sensibilisant à des enjeux de santé spécifiques à leur communauté. Ce projet interdisciplinaire offre aussi aux futurs professionnels et professionnelles une expérience unique qui contribue au développement de leur professionnalisme, en plus de leur permettre d'intégrer les connaissances acquises et de devenir des leaders culturellement compétents d'un mouvement de changement. Conclusion: Ce projet innovant a permis de se rapprocher des Premières Nations, de mieux comprendre leurs enjeux de santé, de briser les préjugés et d'établir un dialogue pérenne de même qu'un partenariat durable avec ses membres. Ainsi, la Faculté poursuit les objectifs des démarches de réconciliation entamées par l'Université Laval visant à favoriser la réussite scolaire et à sensibiliser la communauté universitaire aux réalités autochtones., Background/Purpose: Immersion in other cultures is a transformative learning opportunity for learners to become lifelong advocates for all their patients. To measure the efficacy of these experiences, a validated instrument to measure change on the relative cultural sensitivity, is necessary. The last validated instrument was revised in 2002 (Beswick & Hills, 1969; Neuliep, 2002; Neuliep & McCroskey, 1997). We live in a different era than when these items were written and crafted. In order to sincerely understand people's latent perceptions, we need a shrewder instrument and one that cannot be as easily gamed for a socially desirable outcome. Methods: This instrument development combined 12 expert consultations and the narrative experiences of 95 health professions students and then rigorously applied item-response theory and instrument development science to develop a generalizable scale of cultural perceptions. Conclusion: The developed scale was prototyped with an interprofessional sample of health professions students and analysed using correlation analyses and exploratory factor analysis revealing a 2-factor structure. Based on these findings, items were dropped and the scale trimmed to a final form. Conclusion: The scenarios and constructs of this instrument are highly interdisciplinary and transferable across health professions and beyond. For example, electives and placements for nurses, physiotherapists, and medical trainees are designed to expose learners to many different health provision and learning contexts that may have very different cultural feels to them. This instrument would offer a means for these training programs to measure the increase in advocacy and cultural sensitivity in these learners. We look forward to freely sharing our learning and instrument with any health professions educator to promote the development of health advocates everywhere., Background/Purpose: There is increasing effort among medical schools to recruit a diverse student body. However, there is a paucity of research into the unique experiences of students with diverse backgrounds during their transition to medicine. The purpose of this study was to explore first year medical students' experiences and expectations with respect to diversity and inclusion during medical school orientation. Methods: Between April and August 2019, 16 first-year Canadian medical students completed audio-recorded semi-structured interviews. Interviews explored how issues of diversity and inclusion during orientation affected students' transition into medicine and their professional identity development. Interviews were transcribed and analyzed for common themes using descriptive analysis. Results: As early as their first week as medical students, participants reported feeling a disconnect between their institution's message of diversity and inclusion and their own experiences of these issues during orientation activities. They described complex social pressures and an early stratification during orientation based on their social identity. The perceived disconnect became more apparent as the school year progressed. Participants proposed tangible suggestions for institutional improvement of orientation vis-a-vis diversity and inclusion. Conclusion: Longstanding issues of diversity and inclusion in medicine manifest from day one of medical school. While orientation may be seen as a student-run week to welcome students into the profession, it is a crucial period for medical schools to properly set the stage to intentionally demonstrate its commitment to an inclusive culture and meaningful professional identity development. To address these issues later in the school year is too late., Background/Purpose: Le rôle d'éducateur fait partie intégrante de la pratique médicale dès le début de la formation. Il se traduit par des activités de supervision, de présentations ou autres types d'activités de formation auprès des collègues et autres intervenants. Ce rôle intègre plusieurs compétences CanMeds, notamment la communication, la collaboration, l'érudition, et l'expertise. L'apprentissage de cette compétence est souvent implicite ou informel dans les curriculum pré doctoraux. Dans le cadre de la refonte du programme de médecine, nous avons construit des activités pédagogiques intégrées et longitudinales soutenant le développement du rôle d'éducateur. Summary of the Innovation: Les activités pédagogiques sont déployées tout au long des quatre années du programme et préparent les étudiants à agir dans trois principaux contextes en lien avec leur rôle d'éducateur soit : 1. Le partage des connaissances en petits groupes, 2. La présentation efficace en milieu clinique, 3. L'apprentissage et la supervision en milieu clinique. Chacune de ces activités visent l'acquisition de connaissances, leur intégration dans des activités pratiques en situation réelles et le développement de la pratique réflexive. Les acquisitions sont supportées par des méthodes pédagogiques interactives centrées sur l'apprenant. L'évaluation est fondée sur des examens écrits et sur l'observation directe. Conclusion: Le développement du rôle d'éducateur s'est concrétisé dans des activités pédagogiques dédiées qui rendent explicites les apprentissages sous-jacents. La pertinence de ces activités pour la pratique future est soulignée par les professeurs impliqués. L'intégration des compétences de collaboration et de communication est particulièrement appréciée des étudiants., Background/Purpose: Distributed medical education (DME) has increased by 30% in Ontario and innovative planning to support and advance scholarly work within these diverse teaching environments is required to ensure equivalent academic opportunities for faculty and students. In order to advance scholarship, an innovative approach was undertaken by all six DME programs associated with the Ontario Faculties of Medicine to reach consensus on five recommendations to be actioned in a coordinated and collaborative process, with the potential for knowledge and resource sharing for greater impact across DME settings. Summary of the Innovation: The academic leads of Ontario's 6 DME programs participated in a semistructured facilitated session to share and compare current state of DME scholarly activities and resources. Five improvement opportunities with relevance to all sites were identified, and recommendations were developed by consensus to address these. The recommendations focused on ensuring that DME program faculty have necessary skills and tools to participate in and supervise scholarly work, and have opportunities for academic promotion and career advancement. The importance of nurturing a culture of recognition and value in scholarship that extends beyond the traditional academic health sciences centres, and of ensuring the relevance of academic work to the communities in which DME scholarship occurs were also highlighted. Conclusion: This is the first time that DME leaders from 6 Ontario medical schools have collaborated to advance scholarly work across different distributed clinical settings. Sharing ideas, solutions and resources will be the most effective way forward to ensure this is accomplished., Background/Purpose: La recherche est intimement liée à la pratique des médecins qui doivent régulièrement interpréter et s'appuyer sur des données probantes, ou participer à la réalisation de celles-ci. L'Association des facultés de médecine du Canada a souligné également l'importance d'inclure la recherche à la formation médicale. La recherche sollicite plusieurs rôles CanMeds, particulièrement l'érudition, la collaboration et l'expertise. Dans le cadre de la refonte du doctorat en médecine de l'Université de Sherbrooke, nous avons construit un parcours soutenant le développement des compétences en recherche pertinentes à la pratique médicale. Summary of the Innovation: Les activités du parcours se déploient en 3 étapes avec, en alternance, des activités permettant l'acquisition et l'utilisation des connaissances et des projets adaptés aux étapes de la formation. À la première étape, des séances d'apprentissages par équipes (APÉ) et des rencontres supervisées soutiennent la rédaction et la vulgarisation d'un résumé scientifique. À la 2e étape, les séances d'APÉ sont suivies du développement individuel et de la présentation d'un protocole de recherche. À la 3e étape, les étudiants doivent participer à une collecte de données dans le cadre d'un projet de recherche longitudinal collectif impliquant une cohorte de plusieurs milliers de patients et analyser les données pour répondre à une question de recherche. Les activités des étudiants sont réalisées sous la supervision de professeurs-chercheurs. Conclusion: Le programme soutient l'intégration de la recherche au développement de la pratique médicale dans une approche par compétence. Les professeurs-chercheurs et les étudiants apprécient la pertinence des activités, et leurs apports au développement de la collaboration et de la communication. De plus, le parcours suscite l'intérêt des étudiants à s'impliquer dans des projets de recherche., Background/Purpose: Professionalism is expected to be developed in medical students during their training in medical school and also during their rotations at hospitals. Despite the effort of keeping the educational environment positive, there are still unprofessional behaviors that could negatively impact students. This study aimed to apply the Holmes' approach which uses unprofessional behaviors observed in clinical settings to facilitate reflection among students upon their entrance in clinical rotations. Methods: A total of 75 medical students, upon starting their internal medicine clerkship, were enrolled in the study and were randomly assigned to the control and intervention groups. For the intervention group, we organized a longitudinal program within 16 weeks, based on four steps of the Holmes' reflection approach: priming, noticing, processing, and choosing. To evaluate the effectiveness of the program, we measured several outcomes in both groups before and after the program, using a situational judgment test (SJT), Queen's University Belfast Professionalism Index (QUBPI), and Professionalism Mini-evaluation Exercise (P-MEX). Results: Scores of SJT increased in the intervention group at the end of the program (from 7.56 to 10.17; P≤ 0.001), while there was no significant difference in the controls' scores. There were no significant changes in scores of QUBPI (attitude towards professionalism) and P-MEX (professional behavior) comparing control and intervention groups before and after the program. Conclusion: Based on our findings, Holmes' reflection approach increased the medical students' knowledge of professionalism upon entering the clinical setting significantly, but long-term follow-up is required to evaluate the effects of this reflection approach on other desirable outcomes., Background/Purpose: Navigating Ottawa Resources to Improve Health (NORTH) is an innovative, interdisciplinary, student-run clinic that aims to connect clients with identified social needs, to community resources. Medical, social work, and law students work together as navigators, supervised by a community social worker. To our knowledge NORTH is the first student clinic in Canada devoted entirely to addressing social determinants of health (SDOH). The aim is to address the social needs of clients, while providing students with the opportunity to build competencies in SDOH, communication, and interdisciplinary teamwork that will be necessary as future professionals. Summary of the Innovation: The clinic was piloted at the Bruyère Family Health Team in Ottawa and ran from January to August 2018. Thirty-one referrals were received, the majority from physicians and social workers. Twenty of which were seen by NORTH navigators. While many clients had multiple reasons for referral, income support was the most common need. Of 53 scheduled visits, 40 were successfully completed (23 in person, 17 over the phone). Survey results showed that NORTH was well received by both referring providers and clients. Both groups felt that the limited hours of operation was the most significant barrier. Nevertheless, both responded positively to the timeliness in addressing referrals and appointments. Conclusion: Results of the pilot suggest that NORTH has great potential in terms of addressing SDOH challenges faced by clients. However, issues with continuity of care, missed appointments and logistical challenges need to be addressed moving forward. Many lessons were learned from this pilot which can be implemented in the clinic. Next steps also include evaluating the pedagogical value of the clinic for student navigators., Background/Purpose: Recently, leadership has gained new relevance in medicine in Canada. A 2015 revision to the CanMEDS framework included the new leader role. This emphasis on leadership, although exciting, presents challenges to medical education as current undergraduate medical leadership curricula are lacking. It is important to design effective leadership curricula for medical professionals targeting early stages of training. To design relevant undergraduate medical leadership curricula, it will be necessary to explore medical students' perceptions of physician leadership. Methods: This was an exploratory qualitative descriptive study. Medical students in their 1st, 2nd and 3rd years were recruited by email and in-person. Participants took part in an approximately one hour-long semi-structured interview exploring different topics in leadership. Interviews were audio-recorded and then transcribed by a professional transcription agency. Interview transcripts were coded and analyzed thematically. Results: In total, 24 students were interviewed, fourteen 1st years, three 2nd years and seven 3rd years. Students shared various perspectives on three aspects of leadership, character, competence and commitment, as well as general views on leadership. Identified themes included the discussion of positional and dispositional leadership, leadership being an individual choice, the association between character and personality and one's ability to develop character. Conclusion: Overall, many students saw the relevance of the character, competence and commitment aspects of leadership. However, there were many varied views on leadership as students have different past experiences and teachings on leadership. This research provides important insights for the development of future undergraduate character-based leadership curricula., Background/Purpose: Over 50% of Canadian medical students report experiencing mistreatment, yet only a small proportion of students report these concerns to school administration. It is unknown how medical students make sense of their experiences of mistreatment and come to decide whether to formally report these experiences. A better understanding of this phenomenon will facilitate changes by the medical school to better support students Methods: This Constructivist Grounded Theory study interviewed 19 current and former medical students from one institution about their experiences with mistreatment and reporting. Anonymized transcripts were reviewed, coded and theory was developed. Results: Students undergo a journey surrounding experiences of mistreatment in five phases: Situating, Experiencing and Appraising, Reacting, Deciding, and Moving Forward. Students move through these phases as they come to understand their position as medical learners and their ability to trust and be safe within this institution. Each experience of mistreatment causes students to react to what has happened to them, and then decide if they will share their experiences and reach out for support. They choose if they are going to report the mistreatment, at what cost and for what outcomes. Students continue through their training while incorporating their experiences into their understanding of the culture in which they are learning and continually resituating themselves within the institution. Summary: Students undergo a journey surrounding experiences of mistreatment in five phases: Situating, Experiencing and Appraising, Reacting, Deciding, and Moving Forward. Students move through these phases as they come to understand their position as medical learners and their ability to trust and be safe within this institution. Each experience of mistreatment causes students to react to what has happened to them, and then decide if they will share their experiences and reach out for support. They choose if they are going to report the mistreatment, at what cost and for what outcomes. Students continue through their training while incorporating their experiences into their understanding of the culture in which they are learning and continually resituating themselves within the institution. Conclusion: This study revealed institutional mistrust from students especially as it related to reporting mistreatment. Interventions designed to support students and decrease exposure to mistreatment may be best focused on increasing organizational trust between students and medical school leadership. Students volunteered mechanisms to support them. Medical school administration should consider how they can increase trust with their learners while identifying areas of concern and procedures for intervening and providing more transparent resolutions., Background/Purpose: High levels of burnout, anxiety, and depression among medical trainees are linked to reduced workplace productivity, empathy, and professionalism. Medical students are not accessing mental health resources, citing limited time, and concerns regarding confidentiality, cost, and stigma. This study aims to identify perceived barriers and successful strategies for accessing mental health resources by Ontario (ON) medical students. Methods: Between May-Sep 2019, semi-structured telephone interviews were conducted with 16 medical students from ON medical programs. Students were purposively sampled for year of training, perceived stress levels, and experiences in accessing wellness resources. A descriptive thematic approach was used for analysis. Interview questions focused on identifying barriers and promoting factors for maintaining wellness, and on suggestions for wellness improvement. Results: Three main themes were identified: barriers to accessing care; maintaining and promoting wellness; and navigating professionalism and the “hidden curriculum”. Students identified significant administrative and resource barriers, including inflexible leave of absence policies, remote locations for clinical experience away from supports, frequent travel during clerkship, and time constraints/crisis management. Stigma, and fear of career consequences were frequently cited as concerns with the “hidden curriculum”. Peer support and mentorship from attending physicians were instrumental in facilitating student access to mental health resources. Conclusion: The identified wellness barriers and promoting factors will be further explored in future province-wide survey studies. This information will be used to inform policy changes in medical education to improve student wellness., Background/Purpose: While trainees enter medical school with similar baseline wellness characteristics to age-matched peers, their wellbeing declines significantly during training in comparison, highlighting the role our medical training environment has on wellbeing. To change this trajectory we need comprehensive, strategic wellness initiatives that go beyond programming. The CFMS first created our national wellness program(NWP) 2 years ago to address these challenges. Summary of the Innovation: The NWP is composed of 4 pillars; Awareness, Advocacy, Programming, Resilience and Personal Development. Our awareness arm highlights students in their unique wellness journeys and “normalizes” discussions around challenges in medicine. Our advocacy pillar focuses on learner mistreatment and systemic interventions to create a health promoting working and learning environment. Our programming pillar includes the national wellness challenge (over 800 participants, a majority who report their wellness is positively influenced) and our longitudinal wellness initiative, which provides resources to promote nutrition, mental, physical, financial and social/relationship wellness. In promoting resilience and personal development we are providing free STRIVE (Simulated Training for Resilience in Various Environments) training that utilizes the Big4+ concepts. We also facilitate “Safe Space: Let's Get Real” national discussions for members to speak openly and collaborate on wellness challenges. Conclusion: The CFMS national wellness program represents the first comprehensive student-led national level medical student wellness program. Based on learner qualitative surveys, participation and other quality indicator measures we have to the medical learning environment in our first 2 years. The CFMS looks forward to continuing this work with an upcoming 3 year strategic vision., Background/Purpose: Mistreatment is a widespread problem at Canadian medical schools. It is associated with the development of significant psychological morbidity and impaired professional attitudes. At McGill University, the student council determined, through discussions with its members, that a specific rotation presented a higher rate of mistreatment events. Further investigation identified that most students had failed to report the events through the Faculty mistreatment reporting process. This study's objective was to identify barriers to students reporting mistreatment in a clinical environment at a Canadian medical school. Methods: The two main student communication channels (Facebook class groups and weekly student council newsletter) were used to recruit students from two different graduating classes. Three members of student council were identified as contact persons. 24 interviews were held by phone or in person over the span of one month. Interviewees were guaranteed anonymity. Interviewers noted interviewees' reasons for non-reporting. A narrative analysis looking for emerging themes was subsequently conducted. Results: Reasons students do not report mistreatment through the official process can be classified into four categories: 1) students' lack of trust that their report will have any impact on the system, 2) students' fear of potential repercussions on their future careers, 3) students' understanding and recognition of mistreatment and 4) tediousness of the reporting process. Conclusion: Canadian medical schools should consider these reasons when creating their mistreatment reporting processes in order to ensure students' trust, anonymity, awareness, and to ensure that the process remains simple and straight to the point., Background/Purpose: Moral distress and its consequences (burnout, attrition), are deleterious to health care workers, to patients and the health care system. We aimed to explore commonly reported causes and consequences of moral distress in ICU physicians, but also relationships with broader conditions and consequences related to ICU physicians' wellbeing. Methods: We conducted a national cross-sectional survey, including structured and free-text comments, to understand the magnitude, causes and consequences of moral distress as well as other wellness measures in ICU physicians in Canada. Inductive thematic analysis of the free text comments of survey respondents by an inter-disciplinary team of four investigators who have expertise in qualitative research. Results: Eighty-three of the 225 survey participants shared 135 written comments, which identified contextual and relational factors that contributed to either moral distress or work-related stress in the ICU. Certain factors appeared modifiable, whereas others were not under physicians' control. As these challenges drew upon limited ICU physicians' resources, cumulative stressors represented a threat to wellbeing, but also impacted physicians' relationships with other healthcare professionals, patients and relatives, and physicians' family members. Occurrence and consequences of moral distress varied across physicians. Many participants described their work as rewarding. These rewards combined with individual coping strategies helped ICU physicians face work-related stressors. Conclusion: Understanding moral distress among practicing physicians is important for medical education. Relational factors involved in physician's distress and professional rewards are more likely to be effectively targeted by educational interventions than contextual factors., Background/Purpose: Work hour regulation has failed to solve the problem of fatigued physicians. Organizations are turning to fatigue risk management (FRM) frameworks utilized in other high-reliable industries, which assume a shared understanding of fatigue as hazardous. Although physicians reliably recognize when they are tired, it remains unclear how they perceive the impact of their workplace fatigue. Thus, we set out to explore physician, nurse and resident perspectives on the impact of physician fatigue. Methods: Using a constructivist grounded theory approach, we conducted 40 interviews with staff physicians (20), residents (8) and nurses (12) from six departments practicing in a tertiary academic centre or community hospital in Ontario, Canada. Iterative data collection and analysis directed theoretical sampling. Constant comparative analysis raised our initial open coding to a more conceptual level, resulting in the final grounded theory. Results: Participants held paradoxical views about physician fatigue. They described multiple manifestations of fatigue in clinical work (e.g. slowness, incorrect orders, poor communication) while maintaining that fatigue minimally impacts patient care. Our analysis revealed four main themes within this duality: (1) the idea of indefatigable physicians, (2) the reliance on a safety net, (3) the absence of proof and (4) the minimization of fatigue-related events. Conclusion: Healthcare providers are working within a complex framework that sustains contradictory perspectives about the significance of fatigue. This “fatigue paradox” may be necessary since existing systems expect fatigued physicians to provide patient care. Left unchallenged and unexamined, paradoxical perceptions of physician fatigue may impede successful implementation of fatigue risk management in practice., Background/Purpose: The transformation of teaching units into interprofessional (IP) care teams has created opportunities for non-physician teachers (Health Professional Educators - HPEs) to take on roles as teachers in Family Medicine (FM). The integration of HPEs has historically been on an informal basis, with implications for the quality of education experienced by both learners and teachers. In 2015, the Department of Family and Community Medicine (DFCM) at the University of Toronto launched an innovative faculty development program to formally recognize the important role that non-physician Health Professional Educators (HPEs) (such as nurses, pharmacists, social workers and others) play in the training of medicine learners. Summary of the Innovation: Lead by an HPE and physician co-leadership model, this initiative has resulted in a number of successful outcomes to better support this often hidden cohort of medical educators, including: the creation of guidelines and a more robust process for HPE faculty appointments (with an increase in the number of HPE appointments attained); implementation of targeted HPE communication strategies (website, newsletters); increased visibility of HPEs in planning and attending faculty development activities (leading to more engagement at clinical teaching sites); and the establishment of a Community of Practice (CoP) for peer teacher support, now with approximately 125 members. Conclusion: This presentation will summarize the structure and achievements of the DFCM's HPE Program to date, utilizing Stufflebeam's CIPP model of program evaluation (Frye & Hemmer, 2012) to describe the context, input, process/methods and products of this innovative program. Key program enablers, opportunities and costs, and plans for ongoing activities will also be described., Background/Purpose: Patients' networks of care providers have largely been ignored in current models of history taking. That each patient has a family physician who helps them navigate the healthcare system is largely assumed. For many hospitalized patients - especially those with multi-morbidity - this may not accurately reflect their reality. Moreover, failing to consider alternative care networks could lead to inadequate care planning. Methods: Prospective cohort study with data collection and analysis informed by constructivist grounded theory methodology. Data included interview transcripts from 30 patients admitted to an inpatient internal medicine service of an urban academic health centre. Analysis and data collection proceeded in an iterative fashion with sampling progressing from purposive to theoretical. Results: We found a complex interplay among the types of family physician relationship (highly involved, less involved, non-existent), specialist relationship(s) (highly involved, consultative, fragmented), and patients' personal abilities/social supports. These configurations appeared to impact how each cared for self and navigated the healthcare system. Those with less optimal combinations described many challenges during transitions in medical care arising from hospital admission, new diagnoses, increasing medical complexity, and changes in functional ability. Conclusion: Our elaboration of the multiple configurations of care networks has implications for teaching history taking. Adapting history taking to more effectively identify care networks can help guide discharge and ongoing care planning for high risk patients. Doing so requires moving from “past medical history” to “chronic active issues,” and exploring the associated network of care providers and social context., Background/Purpose: University of Toronto's Internal Medicine clerkship written exam occurs on a Friday morning. Overnight call is cancelled Thursday night. 50% of students are on call the weekend before the exam: either Friday and Sunday night or Saturday night. Students on call Saturday night are also on call Wednesday night. The Wednesday shift ends less than 24 hours before the exam. Remaining students are only on call Monday or Tuesday night. Students often express concern about the perceived impact of weekend call on studying and Wednesday call on cognition. Shift work has been shown to alter circadian rhythm for up to 3 days. This study aimed to determine whether call schedules influenced Internal Medicine exam grades. Methods: Data from 2015-2017 was retrospectively analyzed including 465 students from 5 academic hospitals. Archived call schedules were used to group students by their pre-exam call schedule. Student grades on the Internal Medicine written exam were analyzed for each group and adjusted for the students' grades on the wards and the oral exam. Results: Students with Friday/Sunday call (n=86) and Saturday/Wednesday call (n=87) scored 77.28%+/-8.82% and 76.46%+/-8.76% respectively. Students without weekend call (n=292) scored 76.44%+/-8.77%. There was no significant difference between groups before or after adjusting for ward and oral exam grades. Conclusion: There was no significant difference between grades regardless of when students had overnight call. Clerkship directors may use this data to inform call schedules. Further studies regarding study habits and satisfaction may inform the impact of pre-exam call schedules on student wellness., Background/Purpose: The Family Medicine residency program at the University of Ottawa offers a humanities curriculum to strengthen the CanMEDS-FM competencies of their trainees. This study assesses its impact on the residents' perception of the development of patient-centred skills. Methods: Thematic analysis was done on anonymous written activity evaluations from 2007 to 2018 and on 11 anonymized peer interviews of resident physicians who attended at least one (1) educational activity between 2016 and 2018. Both the NVivo software and a paper-based approach were used for analysis. Initial coding was done following the competencies listed in the CanMEDS-FM framework. In addition to descriptive quantitative statistics obtained through NVivo, CmapTools was used to produce two (2) thematic maps: one for the written evaluations; and the other for the interviews. Results: Although all CanMEDS-FM competencies were covered by the curriculum, there was a strong dominance of the communicator, collaborator, professional and health advocate ones. The communicator competency was more prominent in the written evaluations, as opposed to the professionalism one in the interviews. Ancillary themes were the value of the contents, the time constraints surrounding involvement in the curriculum, and the initiation of personal reflection about one's practice. Conclusion: The existing humanities curriculum is perceived by participating residents to have a positive impact on the development of CanMEDS-FM competencies, especially the ones required for a sustainable clinical practice. Updates of the material used during educational activities and protected academic time could further the impact of the curriculum among residents., Background/Purpose: New graduate health care professionals face challenges when transitioning from training to employment. However, employers looking to the literature to inform the development of supports to ease transition to practice will find weak evidence. The aim of this research was to begin to address this gap by exploring newly hired new graduate occupational therapist experiences of onboarding activities to better understand what they value and why. Methods: A constructivist phenomenological approach was used. Semi structured interviews were conducted with new graduate occupational therapists working in urban hospital settings. Interviews were audio recorded, transcribed, de-identified and coded. A series of iterative discussions were used to review and revise codes and themes and to organize the data at a conceptual level. Results: Employers initiated a range of formal onboarding activities. Experiences of these activities were impacted by environmental factors that either facilitated or impeded their function or compensated for a lack of formal support. New employees described initiating activities themselves that acted in addition to, or compensated for, a lack of formal support. Employee-initiated activities were also facilitated or impeded by environmental factors. Conclusion: Our findings suggest that employers of new health professionals should tailor the supports they provide based on the employees' past experience and ability to act proactively to create their own supports, while being conscious to account for or modify the nature of the work environment. Secondly, they suggest there is value in employers using transition to employment best practices to support new graduate health professionals' transition to practice., Background/Purpose: Simulation based education (SBE) is a frequently used method of teaching in medical curricula. Whilst considered safe from a patient perspective, learners can often experience a range of emotions including fear and anxiety. Given that emotions are potent learning mediators, many have called for greater insight to learner's emotional states in simulation. This study sets out to provide a deep understanding of the lived experience of learners emotions in SBE. Methods: A qualitative study was conducted using Hermeneutic phenomenology. Medical students were recruited and purposefully sampled to engage in a ward based simulation exercise. While wearing video-glasses - first person PoV video-footage was captured and used to elicit interviews with participants following the simulation. Interviews were transcribed and analysed using the Template Analysis approach in an interpretive, iterative and reflexive fashion. Results: Four main themes emerged 1) 'Nervous anticipation' 2) 'Shock and awe' 3) 'Emotions in the moment' 4) 'Safe landing?' Conclusion: The embodied nature of SBE has potential to evoke a range of emotions in learners. Given the unpredictable nature of clinical performance by a learner in a simulation, their emotional states are also dynamic and emergent. There is never static in the complex interplay between perceived performance and learners emotional states. Constant reconfiguring occurs between emotions and perceived performance - with a fine balance between maintaining a dynamic learning equilibrium or volatility. By raising surface awareness of these complex emotional states, can allow educators to take action in their teaching practice. Not only by modify the degree of challenge intra-simulation, but also attending to psychological safety prior to and after simulation.

ObjectivesAs Canada’s second largest province, the geography of Quebec poses unique challenges for trauma management. Our primary objective was to compare mortality rates between trauma patients treated at rural emergency departments (EDs) and urban trauma centres in Quebec. As a secondary objective, we compared the availability of trauma care resources and services between these two settings.DesignRetrospective cohort study.Setting26 rural EDs and 33 level 1 and 2 urban trauma centres in Quebec, Canada.Participants79 957 trauma cases collected from Quebec’s trauma registry.Primary and secondary outcome measuresOur primary outcome measure was mortality (prehospital, ED, in-hospital). Secondary outcome measures were the availability of trauma-related services and staff specialties at rural and urban facilities. Multivariable generalised linear mixed models were used to determine the relationship between the primary facility and mortality.ResultsOverall, 7215 (9.0%) trauma patients were treated in a rural ED and 72 742 (91.0%) received treatment at an urban centre. Mortality rates were higher in rural EDs compared with urban trauma centres (13.3% vs 7.9%, pConclusionsTrauma patients treated in rural EDs had a higher mortality rate and were more likely to die prehospital or in the ED compared with patients treated at an urban trauma centre. Our results were limited by a lack of accurate prehospital times in the trauma registry.

This study examined the prevalence of emergency department visits prompted by panic attacks in patients with non-cardiac chest pain. A validated structured telephone interview was used to assess panic attacks and their association with the emergency department consultation in 1327 emergency department patients with non-cardiac chest pain. Patients reported at least one panic attack in the past 6 months in 34.5 per cent (95% confidence interval: 32.0%–37.1%) of cases, and 77.1 per cent (95% confidence interval: 73.0%–80.7%) of patients who reported panic attacks had visited the emergency department with non-cardiac chest pain following a panic attack. These results indicate that panic attacks may explain a significant proportion of emergency department visits for non-cardiac chest pain.

OBJECTIVES We sought to reduce the 90% rate of missed diagnoses of panic-like anxiety (panic attacks with or without panic disorder) among emergency department patients with low risk noncardiac chest pain by validating and improving the Panic Screening Score (PSS). METHOD A total of 1,102 patients with low risk noncardiac chest pain were prospectively and consecutively recruited in two emergency departments. Each patient completed a telephone interview that included the PSS, a brief 4-item screening instrument, new candidate predictors of panic-like anxiety, and the Anxiety Disorder Interview for the Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition to identify panic-like anxiety. RESULTS The original 4-item PSS demonstrated a sensitivity of 51.8% (95% CI [48.4, 57.0]) and a specificity of 74.8% (95% CI [71.3, 78.1]) for panic-like anxiety. Analyses prompted the development of the Revised-PSS; this 6-item instrument was 19.1% (95% CI [12.7, 25.5]) more sensitive than the original PSS in identifying panic-like anxiety in this sample (χ2(1, N = 351) = 23.89 p < .001) while maintaining a similar specificity (χ2(1, N = 659) = 0.754, p = .385; 0.4%, 95% CI [-3.6, 4.5]). The discriminant validity of the Revised-PSS proved stable over the course of a 10-fold cross-validation. CONCLUSIONS The Revised-PSS has significant potential for improving identification of panic-like anxiety in emergency department patients with low risk noncardiac chest pain and promoting early access to treatment. External validation and impact analysis of the Revised-PSS are warranted prior to clinical implementation. (PsycINFO Database Record

Contexte : Les facultes de medecine francophones au niveau mondial (139), conscientes de leurs obligations, s’engagent pleinement envers leur responsabilite sociale avec l’objectif de repondre au mieux aux besoins des populations qu’elles ont le mandat de servir. En 2012, elles ont mis sur pied un projet international de recherche-action sur la responsabilite sociale. Apres quelques annees de travaux, elles ont recemment elabore un plan strategique pour la periode 2015-2020 pour confirmer leurs engagements, mieux coordonner les actions, en faire un suivi plus rigoureux et en augmenter l’impact. Exegese : Le plan se fonde sur trois axes specifiques d’intervention : l’impact, l’accreditation, les partenariats/collaborations. Ceux-ci sont renforces par trois axes transversaux de soutien : plaidoyer/formation/expertise, dissemination/leadership, organisation/ressources. Les objectifs de chacun des axes ainsi qu’une serie d’actions prioritaires pour la periode 2015-2017 sont presentes. Conclusion : Ce plan strategique confirme l’engagement concret des facultes de medecine francophones envers leur responsabilite sociale pour les prochaines annees.

ObjectivesThe Quebec Emergency Department Management Guide (QEDMG) is a unique document with 78 recommendations designed to improve the organization of emergency departments (EDs) in the province of Quebec. However, no study has examined how this guide is perceived or used by rural health care management.MethodsWe invited all directors of professional services (DPS), directors of nursing services (DNS), head nurses (HN), and emergency department directors (EDD) working in Quebec’s rural hospitals to complete an online survey (144 questions). Simple frequency analyses (percentage [%] and 95% confidence interval) were conducted to establish general familiarity and use of the QEDMG, as well as perceived usefulness and implementation of its recommendations.ResultsSeventy-three percent (19/26) of Quebec’s rural EDs participated in the study. A total of 82% (62/76) of the targeted stakeholders participated. Sixty-one percent of respondents reported being “moderately or a lot” familiar with the QEDMG, whereas 77% reported “almost never or sometimes” refer to this guide. Physician management (DPS, EDD) were more likely than nursing management (DNS and especially HN) to report “not at all” or “little” familiarity on use of the guide. Finally, 98% of the QEDMG recommendations were considered useful.ConclusionsAlthough the QEDMG is considered a useful guide for rural EDs, it is not optimally known or used in rural EDs, especially by physician management. Stakeholders should consider these findings before implementing the revised versions of the QEDMG.

IntroductionEmergency departments (EDs) are an important safety net for rural populations. Results of our earlier studies suggest that rural Canadian hospitals have limited access to advanced imaging services and intensive care units and that patients are transferred over large distances. They also revealed significant geographical variations in rural services. In the absence of national standards, our studies raise questions about inequities in rural access to emergency services and the risks for citizens. Our goal is to build recommendations for improving services by mobilising stakeholders interested in rural emergency care. With help and full engagement of stakeholders, we will (1) identify solutions for improving quality and performance in rural EDs; (2) formulate and prioritise recommendations; (3) transfer knowledge of the recommendations to rural EDs and support operationalisation and (4) assess knowledge transfer and explore further impacts of this participatory action research project.MethodologyWe will use a participatory action research approach. We will plan for a governance structure that includes all stakeholders’ representatives, so throughout this project, stakeholders are fully engaged at every step. Our sample will be 26 EDs in rural Quebec. We will conduct semistructured individual and focus group interviews with relevant and representative participants, including patients and citizens (estimated n=200). Interviews will be thematically analysed to extract potential solutions and other qualitative information.An expert panel (±15) will use an analysis grid to develop consensus recommendations from solutions suggested and will evaluate feasibility, impacts, costs, conditions for implementation and establish monitoring indicators. Recommendations will be transferred to stakeholders using tailored knowledge translation strategies (web platform, meetings and so on).Discussion and expected resultsThis study will result in a comprehensive consensus list of feasible and high-priority recommendations enabling decision-makers in emergency care to implement improvements in rural emergency care in Quebec.Ethics and disseminationThis protocol has been approved by the CSSS Alphonse-Desjardins research ethics committee (Project number: MP 2017-009). The qualitative material will be kept confidential and the data will be presented in a way that respects confidentiality. The dissemination plan for the study includes publications in scientific and professional journals. We will also use social media to disseminate our findings and activities such as communications in public conferences.

Background Collaborative writing applications (CWAs), such as wikis and Google Documents, hold the potential to improve the use of evidence in both public health and healthcare. Although a growing body of literature indicates that CWAs could have positive effects on healthcare, such as improved collaboration, behavioural change, learning, knowledge management, and adaptation of knowledge to local context, this has never been assessed systematically. Moreover, several questions regarding safety, reliability, and legal aspects exist. Objectives The objectives of this review were to (1) assess the effects of the use of CWAs on process (including the behaviour of healthcare professionals) and patient outcomes, (2) critically appraise and summarise current evidence on the use of resources, costs, and cost-effectiveness associated with CWAs to improve professional practices and patient outcomes, and (3) explore the effects of different CWA features (e.g. open versus closed) and different implementation factors (e.g. the presence of a moderator) on process and patient outcomes. Search methods We searched CENTRAL, MEDLINE, Embase, and 11 other electronic databases. We searched the grey literature, two trial registries, CWA websites, individual journals, and conference proceedings. We also contacted authors and experts in the field. We did not apply date or language limits. We searched for published literature to August 2016, and grey literature to September 2015. Selection criteria We included randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-and-after (CBA) studies, interrupted time series (ITS) studies, and repeated measures studies (RMS), in which CWAs were used as an intervention to improve the process of care, patient outcomes, or healthcare costs. Data collection and analysis Teams of two review authors independently assessed the eligibility of studies. Disagreements were resolved by discussion, and when consensus was not reached, a third review author was consulted. Main results We screened 11,993 studies identified from the electronic database searches and 346 studies from grey literature sources. We analysed the full text of 99 studies. None of the studies met the eligibility criteria; two potentially relevant studies are ongoing. Authors' conclusions While there is a high number of published studies about CWAs, indicating that this is an active field of research, additional studies using rigorous experimental designs are needed to assess their impact and cost-effectiveness on process and patient outcomes.

Background Evidence-based indicators of quality of care have been developed to improve care and performance in Canadian emergency departments. The feasibility of measuring these indicators has been assessed mainly in urban and academic emergency departments. We sought to assess the feasibility of measuring quality-of-care indicators in rural emergency departments in Quebec. Methods We previously identified rural emergency departments in Quebec that offered medical coverage with hospital beds 24 hours a day, 7 days a week and were located in rural areas or small towns as defined by Statistics Canada. A standardized protocol was sent to each emergency department to collect data on 27 validated quality-of-care indicators in 8 categories: duration of stay, patient safety, pain management, pediatrics, cardiology, respiratory care, stroke and sepsis/infection. Data were collected by local professional medical archivists between June and December 2013. Results Fifteen (58%) of the 26 emergency departments invited to participate completed data collection. The ability to measure the 27 quality-of-care indicators with the use of databases varied across departments. Centres 2, 5, 6 and 13 used databases for at least 21 of the indicators (78%-92%), whereas centres 3, 8, 9, 11, 12 and 15 used databases for 5 (18%) or fewer of the indicators. On average, the centres were able to measure only 41% of the indicators using heterogeneous databases and manual extraction. The 15 centres collected data from 15 different databases or combinations of databases. The average data collection time for each quality-of-care indicator varied from 5 to 88.5 minutes. The median data collection time was 15 minutes or less for most indicators. Interpretation Quality-of-care indicators were not easily captured with the use of existing databases in rural emergency departments in Quebec. Further work is warranted to improve standardized measurement of these indicators in rural emergency departments in the province and to generalize the information gathered in this study to other health care environments.

Objective The aim was to assess the efficacy of two brief cognitive–behavioral therapy (CBT)-based interventions (7×1-h sessions and 1×2-h session) and a pharmacological treatment (paroxetine), compared to supportive usual care, initiated in the emergency department (ED) for individuals suffering from panic disorder (PD) with a chief complain of noncardiac chest pain (NCCP). We hypothesized that the interventions would be more efficacious than supportive usual care on all outcomes. Method A 12-month follow-up study of patients who received a diagnosis of NCCP in the ED and who met diagnostic criteria for PD ( n =71) was performed. Assessments included several psychological questionnaires and a structured interview. A series of repeated-measures analyses of variances, using a split-plot design, were conducted, as well as planned comparisons to examine the differences. Results The seven-session CBT ( n =19), one-session panic management ( n =24) and pharmacotherapy ( n =13) led to greater improvements in PD severity (primary outcome) compared to supportive usual care ( n =15) at posttest, and no significant difference was noted between the three active interventions. On the other measures, patients improved in all conditions, and the therapeutic gains were maintained up to 1 year following the visit to the ED. Conclusions These results suggests that early intervention, in particular seven sessions of CBT, one session of PM or pharmacotherapy (generic paroxetine), should be considered for the treatment of PD patients consulting the ED with a discharge diagnosis of NCCP.

Objectives The present study aims to document the problem of suicidality in emergency department (ED) patients with unexplained chest pain and to assess the strength and independence of the relationship between panic and suicidal ideation (SI) in this population. Method This cross-sectional study included 572 ED patients with unexplained chest pain. SI, history of suicide attempts, history of SI and the presence of thoughts about how to commit suicide were assessed. Logistic regression analyses were used to quantify the relationship between current SI and panic. Results Approximately 15% [95% confidence interval (CI), 12%–18%] of patients reported current SI, and 33% (95% CI, 29%–37%) reported history of SI. Nearly 19% (95% CI, 16%–22%) of patients had thought about a method to commit suicide, and 33% (95% CI, 29%–37%) had a history of a suicide attempt. Panic attacks were diagnosed in 42% (95% CI, 38%–46%) of patients, and 45% (95% CI, 39%–51%) of those had panic disorder. Panic increased the crude likelihood of current SI [odds ratio (OR)=2.53, 1.4–4.5]. This increase in SI risk remained significant after controlling for confounding factors (OR=1.70, 95% CI, 1.0–2.9). Conclusions Suicidality and SI were common and often severe in our sample of ED patients with unexplained chest pain.

Background Brief and efficacious interventions for panic disorder (PD) in patients presenting to emergency departments (EDs) for chest pain are essential. This study assessed the effects of 2 interventions for this population: a brief cognitive-behavioral therapy delivered by psychologists, and a 6-month pharmacologic treatment initiated and managed by the ED physician. The relative efficacy of both interventions was also examined. Materials and Methods Forty-seven adult patients meeting the diagnostic criteria for PD upon presentation to the ED were assigned to 1 of 3 experimental conditions: a brief cognitive-behavioral therapy (7 sessions), a pharmacologic intervention (paroxetine; 6 months); and a usual care control condition. The primary outcome was severity of PD on Anxiety Disorder Interview Schedule for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition , and secondary outcomes included measures of PD symptoms, depressive symptoms, and cardiac anxiety. Outcome measures were taken at baseline, postintervention, as well as at 3- and 6-month follow-ups. Results Patients receiving either intervention demonstrated significant reductions of PD severity ( P = .012), frequency of panic attacks ( P = .048), and depressive symptoms ( P = .027). Conclusion Taken together, these findings suggest that empirically validated interventions for PD initiated in an ED setting can be feasible and efficacious, and future studies should assess their impact on both the direct (ie, health care utilization) and indirect (ie, lost productivity) costs associated with PD morbidity in this population.

Background: Panic disorder (PD) is a common, often unrecognized condition among patients presenting with chest pain to the emergency departments (ED). Nevertheless, psychological treatment is rarely initiated. We are unaware of studies that evaluated the efficacy of brief cognitive-behavioural therapy (CBT) for this population.Aim: Evaluate the efficacy of two brief CBT interventions in PD patients presenting to the ED with chest pain.Method: Fifty-eight PD patients were assigned to either a 1-session CBT-based panic management intervention (PMI) (n= 24), a 7-session CBT intervention (n= 19), or a usual-care control condition (n= 15). A structured diagnostic interview and self-reported questionnaires were administered at pre-test, post-test, 3- and 6-month follow-ups.Results:Statistical analysis showed significant reduction in PD severity following both interventions compared to usual care control condition, but with neither showing superiority compared to the other.Conclusions: CBT-based interventions as brief as a single session initiated within 2 weeks after an ED visit for chest pain appear to be effective for PD. Given the high prevalence of PD in emergency care settings, greater efforts should be made to implement these interventions in the ED and/or primary care setting.

Purpose This study aimed at (1) establishing the prevalence of paniclike anxiety in emergency department (ED) patients with unexplained chest pain (UCP); (2) describing and comparing the sociodemographic, medical, and psychiatric characteristics of UCP patients with and without paniclike anxiety; and (3) measuring the rate of identification of panic in this population. Basic Procedure A structured interview, the Anxiety Disorders Interview Schedule for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition , was administered to identify paniclike anxiety and evaluate patients' psychiatric status. Anxious and depressive symptoms were evaluated with self-report questionnaires. Medical information was extracted from patients' medical records. Main Findings The prevalence of paniclike anxiety was 44% (95% CI, 40%-48%) in the sample (n = 771). Psychiatric disorders were more common in panic patients (63.4% vs 20.1%), as were suicidal thoughts (21.3% vs 11.3%). Emergency physician diagnosed only 7.4% of panic cases. Principal Conclusions Paniclike anxiety is common in ED patients with UCP, and this condition is rarely diagnosed in this population.

ACADEMIC EMERGENCY MEDICINE 2011; 18:322–325 © 2011 by the Society for Academic Emergency Medicine Abstract Objectives: The objective was to demonstrate the derivation and the preliminary validation of a brief screening score to improve recognition of panic-like anxiety in emergency department (ED) patients with unexplained chest pain. Methods: This cross-sectional study included 507 ED patients with unexplained chest pain randomly assigned to the derivation condition (n = 201) or the validation condition (n = 306). The Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV) acted as the criterion standard for panic diagnosis. Receiver operating characteristic (ROC) curves were used to determine which of the sociodemographic, medical, and questionnaire response variables best predicted the presence of panic-like anxiety in the derivation condition. The selected predictors were entered in a logistic regression analysis to determine variables to be included in the screening score. The predictive validity of the resulting score was evaluated in both conditions. Results: The four-item Panic Screening Score (PSS) identified panic-like anxiety with a sensitivity of 63% (95% confidence interval [CI] = 52% to 73%) and a specificity of 84% (95% CI = 76% to 90%) in the derivation phase. The positive predictive value was 74% (95% CI = 62% to 93%) and the negative predictive value was 76% (95% CI = 68% to 89%). In the validation phase, the sensitivity and specificity were 53% (95% CI = 44% to 62%) and 85% (95% CI = 78% to 89%), respectively. The positive predictive value was 72% (95% CI = 62% to 80%) and the negative predictive value was 71% (95% CI = 65% to 77%). Conclusions: The PSS may be useful to identify patients with unexplained chest pain who could benefit from referral to mental health professionals or their primary care providers for evaluation of panic attack and panic disorder. Prospective studies to improve and validate the PSS, followed by impact analysis, are mandatory before clinical implementation. ACADEMIC EMERGENCY MEDICINE 2011; 18:1–4 © 2011 by the Society for Academic Emergency Medicine

Objective:We sought to assess the applicability of the Canadian Emergency Department Triage and Acuity Scale (CTAS) in the prehospital setting by comparing CTAS scores assigned during ambulance transportation by base hospital (BH) nurses with CTAS scores given by emergency department (ED) nurses on patients' arrival.Methods:We recruited a prospective sample of consecutive patients who were transported to the ED by ambulance between December 2006 and March 2007 for whom a contact was made with the BH. Patients were triaged by the BH nurse with online communication and vital signs transmission. On arrival, patients were blindly triaged again by the ED nurse. We used the quadratic weighted κ statistic to measure the agreement between the 2 CTAS scores.Results:Ninety-four patients were triaged twice by 2 nursing teams (9 nurses at the BH and 39 nurses in the ED). The agreement obtained on prehospital and ED CTAS scores was moderate (κ = 0.50; 95% confidence interval 0.37–0.63).Conclusion:The moderate interrater agreement we obtained may be a result of the changing conditions of patients during transport or may indicate that CTAS scoring requires direct contact to produce reliable triage scores. Our study casts a serious doubt on the appropriateness of BH nurses performing triage with CTAS in the prehospital setting.

Introduction: The Royal College of Physicians and Surgeons of Canada requires emergency medicine (EM) residency programs to meet training objectives relating to administration and leadership. The purpose of this study was to establish a national consensus on the competencies for inclusion in an EM administration and leadership curriculum.Methods: A modified Delphi process involving two iterative rounds of an electronic survey was used to achieve consensus on competencies for inclusion in an EM administration and leadership curriculum. An initial list of competencies was compiled using peer-reviewed and grey literature. The participants included 14 EM residency program directors and 43 leadership and administration experts from across Canada who were recruited using a snowball technique. The proposed competencies were organized using the CanMEDS Physician Competency Framework and presented in English or French. Consensus was defined a priori as >70% agreement.Results: Nearly all (13 of 14) of the institutions with an FRCPC EM program had at least one participant complete both surveys. Thirty-five of 57 (61%) participants completed round 1, and 30 (53%) participants completed both rounds. Participants suggested an additional 16 competencies in round 1. The results of round 1 informed the decisions in round 2. Fifty-nine of 109 (54.1%) competencies achieved consensus for inclusion.Conclusions: Based on a national modified Delphi process, we describe 59 competencies for inclusion in an EM administration and leadership curriculum that was arranged by CanMEDS Role. EM educators may consider these competencies when designing local curricula.

Background Information about recruitment and retention factors and quality of work life (QWL) in rural emergency departments (EDs) is limited. A pilot study was used to determine the feasibility of a large-scale study of these variables in Quebec EDs. Methods Two EDs, approximately 10,000 and 30,000 patients per year respectively, were selected as convenience samples. An online survey containing the Quality of Work Life Systemic Inventory (QWLSI; 34 items) and the Recruitment and Retention Factors Questionnaire (39 items) was sent to ED nurses and physicians of these two EDs. Descriptive statistics of percentage, mean and standard deviation and correlations were used to analyse the data. Results Forty out of 64 eligible workers (62%) gave their consent to participate, but only 20 had completed both questionnaires. Participants’ mean age was 42 years (SD = 11.6). The average participants satisfaction with their access to continuing education was low (Mean = 1.6, SD = 0.8). However, their satisfaction with technical resources (Mean = 2.4, SD = 0.7), pre-hospital and inter-hospital transfer services (Mean = 2.5, SD = 0.6), relationships with colleagues (Mean = 2.7, SD = 0.6) and managers (Mean = 2.2, SD = 0.7), work-life balance (Mean = 2.4, SD = 0.6) and emergency patient access to other departments (Mean = 3.7, SD = 0.6) was in the average. The impact of several aspects of the rural environment (e.g. tranquility) on quality of life was also in the average (Mean = 2.5, SD = 0.7). QWL was in the average, excepted subscale ‘support offered to employee’ for which the QWL was lower. Conclusions Data collection was difficult and the larger study will require strategies to improve recruitment such as a paper alternative. The study showed globally good recruitment and retention factors and QWL for these ED nurses and physicians. These results will help hospital administrations better plan initiatives aimed at improving retention and QWL.

Hydrogen sulfide is a potent lethal gas. Supportive care, nitrite therapy and hyperbaric oxygen are the treatment modalities reported in the literature in cases of hydrogen sulfide exposure. We describe an industrial exposure in which 6 workers inhaled high concentrations of hydrogen sulfide when they entered a closed spreader tank partially filled with liquid swine manure. Five of the 6 lost consciousness, and 2 were agitated and poorly responsive on arrival to the emergency department despite having already received high-flow oxygen for nearly 1 hour. These 2 patients received nitrite therapy followed by orotracheal intubation and hyperbaric oxygen. All patients were discharged home without sequelae after short stays in hospital. The emergency management of hydrogen sulfide exposure is briefly reviewed.

Objectives This study evaluates the impacts of seasonal and lunar cycles on anxiety and mood disorders, panic and suicidal ideation in patients consulting the emergency department (ED) with a complaint of unexplained chest pain (UCP). Methods Patients with UCP were recruited from two EDs. Psychiatric diagnoses were evaluated with the Anxiety Disorders Interview Schedule for DSM-IV. Results Significant seasonal effects were observed on panic and anxiety disorders, with panic more frequently encountered during spring [odds ratio (OR)=1.378, 95% confidence interval (CI)=1.002–1.896] and anxiety disorders during summer (OR=1.586, 95% CI=1.037–2.425). Except for one significant finding, no significant effects of lunar cycles were observed. These findings encourage ED professionals and physicians to abandon their beliefs about the influence of lunar cycles on the mental health of their patients. Such unfounded beliefs are likely to be maintained by self-fulfilling prophecies.

ObjectiveCollaborative writing applications (CWAs), such as the Google DocsTM platform, can improve skill acquisition, knowledge retention, and collaboration in medical education. Using CWAs to support the training of residents offers many advantages, but stimulating them to contribute remains challenging. The purpose of this study was to identify emergency medicine (EM) residents’ beliefs about their intention to contribute summaries of landmark articles to a Google DocsTM slideshow while studying for their Royal College of Physicians and Surgeons of Canada (RCPSC) certification exam.MethodUsing the Theory of Planned Behavior, the authors interviewed graduating RCPSC EM residents about contributing to a slideshow. Residents were asked about behavioral beliefs (advantages/disadvantages), normative beliefs (positive/negative referents), and control beliefs (barriers/facilitators). Two reviewers independently performed qualitative content analysis of interview transcripts to identify salient beliefs in relation to the defined behaviors.ResultsOf 150 eligible EM residents, 25 participated. The main reported advantage of contributing to the online slideshow was learning consolidation (n=15); the main reported disadvantage was information overload (n=3). The most frequently reported favorable referents were graduating EM residents writing the certification exam (n=16). Few participants (n=3) perceived any negative referents. The most frequently reported facilitator was peer-reviewed high-quality scientific information (n=9); and the most frequently reported barrier was time constraints (n=22).ConclusionSalient beliefs exist regarding EM residents’ intention to contribute content to an online collaborative writing project using a Google DocsTM slideshow. Overall, participants perceived more advantages than disadvantages to contributing and believed that this initiative would receive wide support. However, participants reported several barriers that need to be addressed to increase contributions. Our intention is for the beliefs identified in this study to contribute to the design of a theory-based questionnaire to explore determinants of residents' intentions to contribute to an online collaborative writing project. This will help develop implementation strategies for increasing contributions to other CWAs in medical education.

Introduction Rural emergency departments (EDs) are important safety nets for the 20% of Canadians who live there. A serious problem in access to health care services in these regions has emerged. However, there are considerable geographic disparities in access to trauma center in Canada. The main objective of this project was to compare access to local 24/7 support services in rural EDs in Quebec and Ontario as well as distances to Levels 1 and 2 trauma centers. Materials and Methods Rural EDs were identified through the Canadian Healthcare Association's Guide to Canadian Healthcare Facilities. We selected hospitals with 24/7 ED physician coverage and hospitalization beds that were located in rural communities. There were 26 rural EDs in Quebec and 62 in Ontario meeting these criteria. Data were collected from ministries of health, local health authorities, and ED statistics. Fisher’s exact test, the t-test or Wilcoxon-Mann-Whitney test, were performed to compare rural EDs of Quebec and Ontario. Results All selected EDs of Quebec and Ontario agreed to participate in the study. The number of EDs visits was higher in Quebec than in Ontario (19 322 ± 6 275 vs 13 446 ± 8 056, p = 0.0013). There were no significant differences between Quebec and Ontario’s local population and small town population density. Quebec’s EDs have better access to advance imaging services such as CT scanner (77% vs 15%, p < .0001) and most the consultant support and ICU (92% vs 31%, p < .0001). Finally, more than 40% of rural EDs in Quebec and Ontario are more than 300 km away from Levels 1 and 2 trauma centers. Conclusions Considering that Canada has a Universal health care system, the discrepancies between Quebec and Ontario in access to support services are intriguing. A nationwide study is justified to address this issue.

Introduction: Recruitment and retention of healthcare staff are difficult in rural communities. Poor quality of work life (QWL) may be an underling factor as rural healthcare professionals are often isolated and work with limited resources. However, QWL data on rural emergency (ED) staff is limited. We assessed QWL among nurses and physicians as part of an ongoing study on ED care in Québec. Methods: We selected EDs offering 24/7 medical coverage, with hospitalization beds, in rural or small towns (Stats Canada definition). Of Québec’s 26 rural EDs, 23 (88%) agreed to participate. The online Quality of Work Life Systemic Inventory (QWLSI, with 1 item per 34 “life domains”), was sent to all non-locum ED nurses and physicians (about 500 potential participants). The QWLSI is used for comparing QWL scores to those of a large international database. We present overall and subscale QWL scores as percentiles (PCTL) of scores in the large database, and comparisons of nurses’ and physicians’ scores (t test). Results: Thirty-three physicians and 84 nurses participated. Mean age was 39.8 years (SD=10.1): physicians=37 (7.7) and nurses=40.9 (10.7). Overall QWL scores for all were in the 32nd PCTL, i.e. low. Nurses were in the 28th PCTL and physicians in the 44nd (p>0.05). For both groups, QWL was below the 25th PCTL i.e. very low, for “sharing workload during absence of an employee”, “working equipment”, “flexibility of work schedule”, “impact of working hours on health”, “possibility of being absent for familial reasons”, “relations with employees”. The groups differed (pConclusion: Overall QWL among rural ED staff is poor. Groups had similar QWL scores except on career path, with physicians perceiving better long-term prospects. Given difficulties in rural recruitment and retention, these findings suggest that QWL should be assessed in rural and urban EDs nationwide.

Introduction: Trauma remains the primary cause of death in people under 40 in Québec. Although trauma care has dramatically improved in the last decade, no empirical data on the effectiveness of trauma care in rural Québec are available. This study aims to establish a portrait of trauma and trauma-related mortality in rural versus urban pre-hospital and hospital settings. Methods: Data for all trauma victims treated in the 26 rural hospitals and 32 Level-1 and Level-2 urban trauma centres was obtained from Québec’s trauma registry (2009-2013). Rural hospitals were located in rural small towns (Statistics Canada definition), provided 24/7 physician coverage and admission capabilities. Study population was trauma patients who accessed eligible hospitals. Transferred patients were excluded. Descriptive statistics were used to compare rural with urban trauma case frequency, severity and mortality and descriptive data collected on emergency department (ED) characteristics. Using logistic regression analysis we compared rural to urban in-hospital mortality (pre-admission and during ED stay), adjusting for age, sex, severity (ISS), injury type and mode of transport. Results: Rural hospitals (N=26) received on average 490 000 ED visits per year and urban trauma centres (N=32), 1 550 000. Most rural hospitals had 24/7 coverage and diagnostic equipment e.g. CT scanners (74 %), intensive care units (78 %) and general surgical services (78 %), but little access to other consultants. About 40% of rural hospitals were more than 300 km from a Level-1 or Level-2 trauma centre. Of the 72 699 trauma cases, 4703 (6.5%) were treated in rural and 67 996 (93.5%) in urban hospitals. Rural versus urban case severity was similar: ISS rural: 8.6 (7.1), ISS urban: 7.2 (7.2). Trauma mortality was higher in rural than urban pre-hospital settings: 7.5% vs 2.6%. Reliable pre-hospital times were available for only a third of eligible cases. Rural mortality was significantly higher than urban mortality during ED stays (OR (95% IC): 2.14 (1.61-2.85)) but not after admission (OR (95% IC): 0.87 (0.74-1.02)). Conclusion: Rural hospitals treat equally severe trauma cases as do urban trauma centres but with fewer resources. The higher pre-hospital and in-ED mortality is of grave concern. Longer rural transport times may be a factor. Lack of reliable pre-hospital times precluded further analysis.

Introduction:Although emergency departments (EDs) in Canada’s rural areas serve approximately 20% of the population, a serious problem in access to health care services has emerged.Objective:The objective of this project was to compare access to support services in rural EDs between British Columbia and Quebec.Methods:Rural EDs were identified through the Canadian Healthcare Association’s Guide to Canadian Healthcare Facilities. We selected hospitals with 24/7 ED physician coverage and hospitalization beds that were located in rural communities (using the rural and small town definition from Statistics Canada). Data were collected from ministries of health, local health authorities, and ED statistics. A telephone interview was administered to collect denominative user data statistics and determine the status of services.Results:British Columbia has more rural EDs (n 5 34) than Quebec (n 5 26). EDs in Quebec have higher volumes (19,310 versus 7,793 annual visits). With respect to support services, 81% of Quebec rural EDs have a 24/7 on-call general surgeon compared to 12% for British Columbia. Nearly 75% of Quebec rural EDs have 24/7 access to computed tomography versus only 3% for British Columbia. Rural EDs in Quebec are also supported by a greater proportion of intensive care units (88% versus 15%); however, British Columbia appears to have more medevac aircraft/helicopters than Quebec.Conclusions:The results suggest that major differences exist in access to support services in rural EDs in British Columbia and Quebec. A nationwide study is justified to address this issue of variability in rural and remote health service delivery and its impact on interfacility transfers and patient outcomes.

Objective To document the prevalence and characteristics of nonfearful panic attacks (NFPA) and their consequences on panic identification and access to mental health services in patients with noncardiac chest pain. Method This cross-sectional sample included 339 patients with noncardiac chest pain and panic attacks. A structured interview was used to collect data on panic attacks, psychiatric morbidity, sociodemographic variables, and previous consultations with a psychiatrist or psychologist. Medical files were reviewed to assess the rate of NFPA identification in the emergency department. Results In our sample of patients with noncardiac chest pain, 39% of those with panic attacks reported NFPA. Psychiatric morbidity was lower in patients with NFPA than in patients with typical panic attacks (49.6% vs 71.1%), as was the mean number of panic symptoms (6 vs 7.8). The rate of panic attack identification was similar in both the groups, but patients with NFPA were less likely to have consulted a psychiatrist or psychologist during their lifetime (34% vs 46%). Conclusions NFPA were highly prevalent in our sample of emergency department patients with noncardiac chest pain. NFPA is associated with significant psychiatric morbidity but these patients were less likely to follow through with referral to a psychiatrist or psychologist than patients with typical panic attacks were.

Introduction Panic-like anxiety (panic attacks with or without panic disorder), a highly treatable condition, is the most prevalent condition associated with unexplained chest pain in the emergency department. Panic-like anxiety may be responsible for a significant portion of the negative consequences of unexplained chest pain, such as functional limitations and chronicity. However, more than 92% of panic-like anxiety cases remain undiagnosed at the time of discharge from the emergency department. The 4-item Panic Screening Score (PSS) questionnaire was derived in order to increase the identification of panic-like anxiety in emergency department patients with unexplained chest pain. Methods and analysis The goals of this prospective cohort study were to (1) refine the PSS; (2) validate the revised version of the PSS; (3) measure the reliability of the revised version of the PSS and (4) assess the acceptability of the instrument among emergency physicians. Eligible and consenting patients will be administered the PSS in a large emergency department. Patients will be contacted by phone for administration of the criterion standard for panic attacks as well as by a standardised interview to collect information for other predictors of panic attacks. Multivariate analysis will be used to refine the PSS. The new version will be prospectively validated in an independent sample and inter-rater agreement will be assessed in 10% of cases. The screening instrument acceptability will be assessed with the Ottawa Acceptability of Decision Rules Instrument . Ethics and dissemination This study protocol has been reviewed and approved by the Alphonse-Desjardins research ethics committee. The results of the study will be presented in scientific conferences and published in peer-reviewed scientific journals. Further dissemination via workshops and a dedicated website is planned.

Objectives The current study was designed (1) to assess insomnia symptoms and sleep-related beliefs in a population of patients presenting in emergency department with unexplained chest pain (UCP) and (2) to examine the associations between insomnia and pain. Methods This is a report of secondary data from a cross-sectional study performed in the emergency department of 2 academic hospitals. Patients with UCP seen in an emergency department were assessed using sleep questionnaires and the Anxiety Disorders Interview Schedule for Diagnostic and Statistical Manual of Mental Disorders, fourth edition . Results Nearly every second patient with UCP (44%) seen in an emergency department suffered from clinically significant insomnia symptoms. Most patients with an anxiety or a mood disorder had insomnia, but a minority of patients with insomnia had an anxiety or a mood disorder. Insomniacs with an anxiety disorder were similar to insomniacs without comorbid anxiety for sleep-related beliefs and depressive symptoms, and both groups of insomniacs reported more depressive symptoms and faulty beliefs than both groups of good sleepers, i.e., either with or without an anxiety disorder. Results from regression analyses revealed that insomnia was associated with pain on univariate regression analysis and accounted for 1.3% of the variance in both pain intensity and interference. However, this association was rendered nonsignificant when additional variables were added to the model. Conclusions Insomnia symptoms are an important, but often disregarded, feature present in a significant proportion of patients with UCP. As insomnia showed stronger associations with pain than anxiety or depression, it may represent an important factor contributing to the development and recurrence of UCP.

Background Quick reversal of warfarin anticoagulation is important in life threatening bleeding. The aim of this study is to improve the administration delay when using Prothrombin Complex Concentrate (PCC) for the emergent reversal of warfarin anticoagulation in the emergency department. Methods An audit and feedback quality improvement project was conducted in three phases: a retrospective audit phase, an analysis and feedback phase and prospective evaluation phase. The charts of all eligible patients in a single Emergency Department (ED) in Québec, Canada, who received PCC since the introduction of this product in 2009 until October 31, 2011, were retrospectively audited. The administration delay of PCC was calculated from the time of prescription to the time of administration. With the data, we determined where improvements could be attained, and jointly with all stakeholders in the ED and the blood bank, we created an action plan to ensure the timely administration of PCC. The action plan was then implemented and a six-month prospective evaluation study was conducted to determine any improvement. Results Seventy-seven charts were reviewed in the retrospective chart audit. The mean administration delay was 73.6 minutes (STD [34.1]) with a median of 70.0 minutes (25–75% IQR [45.0–95.0]). We found that this delay was principally due to the following barriers: communication problems between the ED and the blood bank as well as delivery inefficiencies. An action plan that involved a flowchart to remind all clinicians how to order PCC and a new delivery method from the blood bank to the ED were developed. During the 6 months following the implementation of our action plan, 39 patients received PCC and the mean administration time decreased to 33.2 minutes (STD [14.2])(p

Background Carbon monoxide (CO) poisoning can be a life threatening condition. Systemic hyperbaric oxygen (HBO) therapy is used to induce CO detoxification. However, little is known about the hemodynamic response to HBO in severely intoxicated patients. Methods We retrospectively analyzed the medical records of 6 CO-poisoned patients treated with propofol, rocuronium bromide, and HBO. The HBO protocol comprised 3 HBO treatments (HBOT1 to HBOT3) within 24 hours. During all HBO sessions heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse blood pressure (ΔBP) were measured every five minutes. Non-parametric tests were used to compare data between HBO sessions. Results HR increased significantly as the number of HBOT increased, from 68 beats per minute (bpm) during HBOT1 to 77 and 86 bpm during HBOT2 and HBOT3, respectively (p

Approximately 20% of Canadians live in rural areas. Compared to their urban counterparts, rural citizens are in poorer health and are at greater risk for trauma and trauma death. There are great challenges providing and accessing rural emergency care in Canada due to inherent greater distances and limited resources. However, few studies have described the level of resources available in rural emergency departments (EDs) in Canada and the challenge this represents for providing safe patient care. There is minimal information on ED use in Canada, and comparison between provinces is limited by differences in the types of data collected. We present the situation in a rural ED in Nelson, British Columbia, after major service cuts took place. The issue of reasonable access to emergency services is discussed in the context of the Canada Health Act (CHA). We argue that with budgetary constraints and rising costs, service attribution may not be evidence based and outcomes will not be compared to established benchmarks. Considerable variability in access to timely patient care may result; further research is required to determine the impact of service cuts prior to their implementation. In 2001, health care services to BC rural populations were reduced. In the region served by Kootenay Lake Hospital in Nelson, services were centralized in a community 74 km away. The intensive care unit, general surgical service, and inpatient mental health ward were closed, and laboratory and radiography services were reduced. As a result, over 1,500 patients per year required transfer for workups, consultations, or a higher level of care, frequently on an emergency basis. This transfer process resulted in delays in obtaining definitive care. A recent report also suggested that the service cuts coincided with worse outcomes. Using data from the Discharge Abstract Database and the Canadian Institute for Health Information, the Fraser Institute published its British Columbia hospital report card in 2011. For example, residents in Nelson fell from fourth place (4 of 47 municipalities in 2001–2002, prior to health cuts) to last in the province in 2008–2009 with respect to ‘‘failure to rescue,’’ which is considered among the most important health quality indicators and describes mortality from complications that arose while a patient was hospitalized. For many, Canada’s universal health care system is a defining feature of this country. Rural citizens may be tempted to look toward the CHA as a safeguard because one of the central components of the CHA is ‘‘reasonable access’’ to care. The ‘‘intent of accessibility criterion’’ of the CHA is set to ensure that Canadians ‘‘have reasonable access to insured hospital, medical and surgical-dental services on uniform terms and conditions, unprecluded or unimpeded, either directly or indirectly, by charges (user charges or extra-billing) or other means (e.g., discrimination on the basis of age, health status or financial circumstances).’’ Yet reasonable access in terms of physical availability of medical services has been interpreted under the CHA using the ‘‘where and as available’’ rule. Thus, residents of a province or territory are entitled to have access to insured health services at the facility where the services are provided and as the services are available in that setting. Moreover, Canadian emergency medical service systems are not part of the CHA; emergency transportation times and direct costs to patients to where services are available will demonstrate great variation across the country. Hence, the ‘‘where and as available’’ nuance confers significant powers to provinces with respect to service

Introduction Emergency departments are important safety nets for people who live in rural areas. Moreover, a serious problem in access to healthcare services has emerged in these regions. The challenges of providing access to quality rural emergency care include recruitment and retention issues, lack of advanced imagery technology, lack of specialist support and the heavy reliance on ambulance transport over great distances. The Quebec Ministry of Health and Social Services published a new version of the Emergency Department Management Guide, a document designed to improve the emergency department management and to humanise emergency department care and services. In particular, the Guide recommends solutions to problems that plague rural emergency departments. Unfortunately, no studies have evaluated the implementation of the proposed recommendations. Methods and analysis To develop a comprehensive portrait of all rural emergency departments in Quebec, data will be gathered from databases at the Quebec Ministry of Health and Social Services, the Quebec Trauma Registry and from emergency departments and ambulance services managers. Statistics Canada data will be used to describe populations and rural regions. To evaluate the use of the 2006 Emergency Department Management Guide and the implementation of its various recommendations, an online survey and a phone interview will be administered to emergency department managers. Two online surveys will evaluate quality of work life among physicians and nurses working at rural emergency departments. Quality-of-care indicators will be collected from databases and patient medical files. Data will be analysed using statistical (descriptive and inferential) procedures. Ethics and dissemination This protocol has been approved by the CSSS Alphonse–Desjardins research ethics committee (Project MP-HDL-1213-011). The results will be published in peer-reviewed scientific journals and presented at one or more scientific conferences.

Contains fulltext : 126221.pdf (Publisher’s version ) (Open Access) BACKGROUND: Collaborative writing applications (eg, wikis and Google Documents) hold the potential to improve the use of evidence in both public health and health care. The rapid rise in their use has created the need for a systematic synthesis of the evidence of their impact as knowledge translation (KT) tools in the health care sector and for an inventory of the factors that affect their use. OBJECTIVE: Through the Levac six-stage methodology, a scoping review was undertaken to explore the depth and breadth of evidence about the effective, safe, and ethical use of wikis and collaborative writing applications (CWAs) in health care. METHODS: Multiple strategies were used to locate studies. Seven scientific databases and 6 grey literature sources were queried for articles on wikis and CWAs published between 2001 and September 16, 2011. In total, 4436 citations and 1921 grey literature items were screened. Two reviewers independently reviewed citations, selected eligible studies, and extracted data using a standardized form. We included any paper presenting qualitative or quantitative empirical evidence concerning health care and CWAs. We defined a CWA as any technology that enables the joint and simultaneous editing of a webpage or an online document by many end users. We performed qualitative content analysis to identify the factors that affect the use of CWAs using the Gagnon framework and their effects on health care using the Donabedian framework. RESULTS: Of the 111 studies included, 4 were experimental, 5 quasi-experimental, 5 observational, 52 case studies, 23 surveys about wiki use, and 22 descriptive studies about the quality of information in wikis. We classified them by theme: patterns of use of CWAs (n=26), quality of information in existing CWAs (n=25), and CWAs as KT tools (n=73). A high prevalence of CWA use (ie, more than 50%) is reported in 58% (7/12) of surveys conducted with health care professionals and students. However, we found only one longitudinal study showing that CWA use is increasing in health care. Moreover, contribution rates remain low and the quality of information contained in different CWAs needs improvement. We identified 48 barriers and 91 facilitators in 4 major themes (factors related to the CWA, users' knowledge and attitude towards CWAs, human environment, and organizational environment). We also found 57 positive and 23 negative effects that we classified into processes and outcomes. CONCLUSIONS: Although we found some experimental and quasi-experimental studies of the effectiveness and safety of CWAs as educational and KT interventions, the vast majority of included studies were observational case studies about CWAs being used by health professionals and patients. More primary research is needed to find ways to address the different barriers to their use and to make these applications more useful for different stakeholders.

The objective was to demonstrate the derivation and the preliminary validation of a brief screening score to improve recognition of panic-like anxiety in emergency department (ED) patients with unexplained chest pain.This cross-sectional study included 507 ED patients with unexplained chest pain randomly assigned to the derivation condition (n = 201) or the validation condition (n = 306). The Anxiety Disorders Interview Schedule for DSM-IV (ADIS-IV) acted as the criterion standard for panic diagnosis. Receiver operating characteristic (ROC) curves were used to determine which of the sociodemographic, medical, and questionnaire response variables best predicted the presence of panic-like anxiety in the derivation condition. The selected predictors were entered in a logistic regression analysis to determine variables to be included in the screening score. The predictive validity of the resulting score was evaluated in both conditions.The four-item Panic Screening Score (PSS) identified panic-like anxiety with a sensitivity of 63% (95% confidence interval [CI] = 52% to 73%) and a specificity of 84% (95% CI = 76% to 90%) in the derivation phase. The positive predictive value was 74% (95% CI = 62% to 93%) and the negative predictive value was 76% (95% CI = 68% to 89%). In the validation phase, the sensitivity and specificity were 53% (95% CI = 44% to 62%) and 85% (95% CI = 78% to 89%), respectively. The positive predictive value was 72% (95% CI = 62% to 80%) and the negative predictive value was 71% (95% CI = 65% to 77%).The PSS may be useful to identify patients with unexplained chest pain who could benefit from referral to mental health professionals or their primary care providers for evaluation of panic attack and panic disorder. Prospective studies to improve and validate the PSS, followed by impact analysis, are mandatory before clinical implementation.

Background Healthcare professionals are increasingly using wikis as collaborative tools to create, synthesize, share, and disseminate knowledge in healthcare. Because wikis depend on collaborators to keep content up-to-date, healthcare professionals who use wikis must adopt behaviors that foster this collaboration. This protocol describes the methods we will use to develop and test the metrological qualities of a questionnaire that will assess healthcare professionals' intentions and the determinants of those intentions to use wiki-based reminders that promote best practices in trauma care. Methods Using the Theory of Planned Behavior, we will conduct semi-structured interviews of healthcare professionals to identify salient beliefs that may affect their future use of wikis. These beliefs will inform our questionnaire on intended behavior. A test-retest of the survey will verify the questionnaire's stability over time. We will interview 50 healthcare professionals (25 physicians and 25 allied health professionals) working in the emergency departments of three trauma centers in Quebec, Canada. We will analyze the content of the interviews and construct and pilot a questionnaire. We will then test the revised questionnaire with 30 healthcare professionals (15 physicians and 15 allied health professionals) and retest it two weeks later. We will assess the internal consistency of the questionnaire constructs using Cronbach's alpha coefficients and determine their stability with the intra-class correlation (ICC). Discussion To our knowledge, this study will be the first to develop and test a theory-based survey that measures healthcare professionals' intentions to use a wiki-based intervention. This study will identify professionals' salient beliefs qualitatively and will quantify the psychometric capacities of the questionnaire based on those beliefs.