Valuing maternal, newborn, child and adolescent health for societal progress - Going beyond the economic orthodoxy of gross domestic product.

AIM: In view of the long-standing recognition that gross domestic product (GDP) does not capture the unremunerated work largely conducted by women upon which societal well-being depends, to discuss the implications for GDP of maternal, newborn, child and adolescent health (MNCAH), and its influences on health, well-being and prosperity across the life course and across generations. METHODS: A wide-ranging discussion of the informal think-tank The Venice Forum was held over two days, with inputs from invited experts in person and online. RESULTS: There was consensus that a strong case could be made for inclusion of unremunerated work largely conducted by women as a positive contribution to GDP in view of its impact on future health and prosperity, and conversely exclusion from GDP of outputs from industries which harm health. CONCLUSION: Taken with the current challenges from COVID, climate change and conflict, there is a compelling need to redefine economic progress through equitable models and metrics that incorporate short-/medium-/long-term societal value of activities that improve MNCAH.

Canadian Conference on Medical Education 2022 abstracts Les résumés de la Conférence canadienne sur l'éducation médicale 2022

Background/Purpose: Au Canada, les facultés de médecine prônent l'équité, la diversité et l'inclusion dans leurs mandats. Cependant, on note que les minorités ethniques notamment noires restent sous représentées dans les effectifs d'admission. Cette discordance génère plusieurs questionnements quant à la concrétisation de ces notions dans leur processus d'admission ainsi que leur degré d'intégration au sein des facultés. Ce projet visait à identifier les facteurs influençant l'admission en médecine et la poursuite des études médicales par les minorités ethniques. Methods:Recher che systématique et analyse narrative des écrits provenant des bases de données Medline (PubMed), PsycINFO, CINAHL, Education source, Eric et Google Scholar. 152 documents en anglais publiés entre 1994 et 2021 ont été répertoriés et traités dans les logiciels Zotero et Covidence. 45 articles ont été retenus et analysés. Results: Sur les 45 articles analysés, 34 (75,5%) traitent de ce sujet chez des étudiants noirs. Seul 1 article se rapporte au contexte canadien. Les barrières identifiées incluent : le mentorat inadapté, une préparation académique inadéquate, les stéréotypes et le syndrome de l'imposteur, le manque de finances et de connaissances préalables sur le métier de médecin. Les facilitateurs identifiés incluent : des programmes visant à augmenter la diversité en médecine, des programmes de mentorat offrant une exposition et sensibilisation précoce à la profession, du soutien financier et du support académique. Conclusion: Ils existent plusieurs barrières et facilitateurs à l'éducation médicale pour les minorités ethniques, plus particulièrement noires. Davantage de recherches canadiennes à ce sujet permettraient de mieux cerner cette problématique à l'échelle nationale. Background/Purpose: Despite the rapidly expanding culture of innovation and entrepreneurship in medicine, there are limited educational opportunities for medical trainees to get hands-on experience with healthcare innovation. The opportunities that do exist rarely include collaboration with other disciplines, which is critical to effectively address complex healthcare challenges. The purpose of the healthcare hackathon is to provide medical trainees with exposure to multi-disciplinary teamwork and core concepts of medical innovation. Summary of the Innovation: The hackathon was a 36-hour invention marathon that brought together interdisciplinary teams of students from all over the world to build prototype solutions to unmet clinical needs. Technical and clinical experts were present to advise teams, and prizes were awarded to top teams. There was a total of 237 participants across 33 countries, with 30 unique disciplines including medicine, computer science, economics, pharmacy and more. The first-placed team of the hackathon was a group from Waterloo, Canada, who built a machine learning algorithm that improves ICU bed allocation with the aim of reducing surgical shut-downs during COVID-19. Conclusion: Healthcare hackathons are a relatively simple and resource-saving way to encourage medical trainees to think creatively and embrace innovation. They bring together people from diverse backgrounds and provide a platform for education, collaboration and acceleration of healthcare innovation. They can be adopted by hospitals, departments, medical schools, etc. to create quality ideas and prototype solutions in just a couple of days. Background/Purpose: Financial literacy correlates with less debt and better retirement planning, leading to an improvement in financial wellness. Medical students and residents often have poor financial literacy and excessive post-graduate debt. Through creating and implementing a financial literacy course, we measured the baseline financial literacy of medical students and residents and whether it changed upon course completion. Summary of the Innovation: We created the Medical Mini-MBA, a six-week course to target common gaps in financial literacy among medical students and res dents. The course delivered weekly topics on: personal finance, investing, real estate & mortgage, physician billing & payment models, income & taxation, and medical specialty selection. Experts taught content and provided examination questions to create a 46-question financial literacy assessment. The exam was delivered to participants before and after the course. 179/276 course participants also enrolled in our study. Conclusion: The financial literacy course improved examination scores by 22% (p<0.01). Self-perception of financial literacy was positively correlated with financial literacy scores (r=0.366, p<0.01). Participants who self-reported low levels of financial stress scored highest on the financial literacy exam (p<0.05). Demographic factors had little to no effect on financial literacy scores. The lack of financial education during medical training must be addressed to improve financial wellbeing of physicians. The Medical Mini-MBA improved financial literacy in medical students and residents. Participant feedback strongly suggests that a financial education intervention would be a valuable addition to the medical curriculum. Future investigations will explore financial knowledge retention and behavioural change pertaining to financial decision-making upon course completion. Background/Purpose: For more than a decade there have been calls for increased global health education in undergraduate medical curricula. Further, there is an emerging trend in American medical schools that students with global health experience are more likely to purse primary care careers. We provide an update on the progress of Canadian medical education to incorporate global health, describe the extent of how global health elective experiences influence students' residency and career choices, and identify next steps for global health education at Dalhousie. Methods: Building off our scoping review presented last year, a web-based survey was created for past Dalhousie Medicine students who completed an undergraduate global health elective in their fourth year of study through the Dalhousie Global Health Office. This survey had students reflect on their past global health experiences, rank the importance of global health in their residency placement decision, and comment on if and how they see global health being incorporated into their medical careers. We also conducted interviews to understand how global health electives contribute to a medical students' education and influence future careers. Results: 21 medical students completed the survey. One emerging trend was that students felt they were personally gaining more from their international electives than their host countries, highlighting the need for reciprocity in international electives. These results re-assert the need for improved global health education, and current overreliance on international electives for global health education. Conclusion: Moving forward, we hope this will help influence programming and curriculum decisions at medical schools across the country. Background/Purpose: Although immigrants are healthier than the general population, their health often deteriorates over time. The multifactorial causes for this deterioration include language, cultural differences, and navigating a new healthcare system. Summary of the Innovation: We co-designed a patient resource to bridge socio-cultural perspectives between immigrant patients and physicians during care;co-design participants included immigrants, community organization representatives, and physicians. We conducted three sets of focus groups (needs assessment, thematic analysis, tool design) with five participants each from the Filipino, Indian and Chinese communities in Calgary (n = 15) over Zoom video conference platform. We recruited participants via an online patient engagement posting and word-of-mouth. Focus group data and iterative feedback informed the co-design of a Calgary-based immigrant healthcare system resource. This resource assists immigrants prior to and during their interactions with healthca e professionals in primary care settings by prompting them with commonly asked questions and tips. Posters, worksheets, and QR codes were created, translated, and trialed among various healthcare settings and immigrant services. Utility, ease of use, and satisfaction with the resource were assessed through mixed methods surveys. Conclusion: Our co-designed immigrant healthcare resource was received favourably, and improved immigrants' confidence when self-advocating and navigating healthcare services. It was learned that the barriers faced by immigrants in Calgary are similar to those faced by non-immigrants, but are greater in magnitude due to interplay with language barriers and pre-existing assumptions regarding Canada's healthcare system. In the future, we aim to scale up and distribute this resource for use in other healthcare and medical education settings. Background/Purpose: Most academic Journal Clubs (JC) focus on critiques of methodology, critical analysis of results, and review the quality and applicability of new knowledge obtained in journal articles. The Master Teacher Program (MTP), a 2-year longitudinal instructional development program for busy clinician-teachers at the Department of Medicine, University of Toronto, runs a JC with very different objectives. Our JC allows participants to: 1) gain exposure to salient medical teaching and education journals, 2) expand teaching content knowledge on a variety of topics, 3) review articles through collegial group discussion, and 4) apply new understanding to enrichpersonal teaching practice. Summary of the Innovation: Each MTP participant is required to present one 30 minute JC session during the Year-2 of the program. They choose an article that is relevant to their teaching or educational needs. All participants read the article beforehand and engage in group discussion. While the format is very flexible, presenters are encouraged to offer a 5-minute summary of the article and then lead a group discussion to: 1) discuss the relevance, 2) emphasize the impact of the published information on teaching or education practice, and 3) delineate issues raised in the article with which they are in agreement or disagreement. Content, teaching practice, and application of the JC article are also highlighted by participants. 68 MTP participants have presented JC from 2017-2021. Conclusion: This JC format expands academic reading, enhances knowledge and application of the literature on medical teaching/education practice, and encourages discussion among busy clinician-teachers in an instructional faculty development program. Background/Purpose: Video-based assessment has been validated in arthroscopy, but it is lacking evidence in open orthopedic procedures. It could allow portable and de-identified methods for objective assessments of competence. Our goal was to assess the validity of video evaluation of orthopedic surgery residents performing simulated open cadaveric procedure. We secondarily sought to explore faculty impressions of the strengths and limitations of video-based assessment. Summary of the Innovation: Methods: Four residents performed simulated open reduction and internal fixation of both bone forearm fracture and underwent live assessment using Ottawa Surgical Competency Operating Room Evaluation (O-SCORE). Their evaluations were videotaped and re-evaluated by five orthopedic surgeons using the same evaluation tool. Intra-rater and inter-rater reliability were calculated. Qualitatively, thematic analysis on semi-structured interviews exploring the strengths and limitations of video-based assessment were conducted. Results: The Interclass Correlation Coefficient for video-based assessment showed good Intra-rater reliability 0.782 (P-value <0.001) and Inter-rater reliability 0.832 (P-Value 0.014). The strengths of video-based assessment according to faculty perception included the ability to re-check missed points during live assessment, more constructive feedback, anonymization and use of multiple assessors. The limitations included the lack of high-fid lity simulated assessment, poor audio-video quality and inability to evaluate readiness for practice. Conclusion: This is the first study to demonstrate that video-based assessment is a reliable and valid assessment tool in open procedures in orthopedics. Audio-video quality should be improved before making high stakes decisions about readiness for practice. Background/Purpose: Preserving an empathetic, humanistic approach has been linked to patient satisfaction, patient safety and physician wellness. This is particularly important in face of a pandemic and the call to foster an understanding of diversity. Medical schools must design their curricula to ensure attributes of professionalism that include empathy, altruism and other humanistic attitudes are instilled. Methods: We tested medical students from year 1 to final year 4 at the University of Ottawa using the IRI (Interpersonal Reactivity Index) on a voluntary basis. The IRI was chosen on basis of solid psychometric properties. It is also freely available for use in English and French. Results: 82 students responded in Year 1, dropping to 32 by Year 4 in 2020 (likely influenced by the start of the pandemic). Post hoc analysis was done with Bonferroni adjustment. On 3 measures of the IRI there was an increase from Year 1 to Year 3, maintained through to year 4. On the fourth measure, Personal Distress throughout the four years students had similar feelings of personal anxiety and unease in tense interpersonal settings with lowest scores. Conclusion: Unlike previous studies demonstrating erosion of empathy in the third year, the IRI shows how empathy scores improved and then maintained in clerkship. This study demonstrates how the IRI can be used to evaluate curriculum interventions designed to enhance or reinforce empathy. Rationalization to employ the IRI is that empathy in medical students can improve the patient experience and contribute to professional identity formation (PIF) for future health professionals. Background/Purpose: Increasingly physicians are choosing to work part-time, to retire early, or to change careers altogether. Burnout has been identified as one of the reasons leading physicians to want to quit practice. Unfortunately, we still know too little about how to intervene to support physicians grappling with such challenges. Recently, the phenomenon of non-clinical “side gigs” (i.e., employment outside what is traditionally associated with a medical career) has become a popular topic of discussion in social media as a means to keep physicians well, motivated and able to stay in the medical workforce. Although there are conferences, podcasts, blogs and online forums that discuss non-clinical work for physicians, however, this possibility has been largely absent from the scientific literature.

Developmental Origins of Health and Disease, resilience and social justice in the COVID era.

The COVID-19 pandemic has shone a spotlight on how health outcomes are unequally distributed among different population groups, with disadvantaged communities and individuals being disproportionality affected in terms of infection, morbidity and mortality, as well as vaccine access. Recently, there has been considerable debate about how social disadvantage and inequality intersect with developmental processes to result in a heightened susceptibility to environmental stressors, economic shocks and large-scale health emergencies. We argue that DOHaD Society members can make important contributions to addressing issues of inequality and improving community resilience in response to COVID-19. In order to do so, it is beneficial to engage with and adopt a social justice framework. We detail how DOHaD can align its research and policy recommendations with a social justice perspective to ensure that we contribute to improving the health of present and future generations in an equitable and socially just way.

Adapting the Admissions Interview During COVID-19: A Comparison of In-Person and Video-Based Interview Validity Evidence.

COVID-19 physical distancing limited many medical schools' abilities to conduct in-person interviews for the 2020 admissions cycle. The University of Toronto (U of T) Temerty Faculty of Medicine was already in the midst of its interview process, with two-thirds of applicants having completed the in-person modified personal interview (MPI). As the university and surrounding region were shut down, the shift was made in the middle of the application cycle to a semisynchronous video-based MPI interview (vMPI) approach. U of T undertook the development, deployment, and evaluation of the 2 approaches mid-admissions cycle. Existing resources and tools were used to create a tailored interview process with the assistance of applicants. The vMPI was similar in content and process to the MPI: a 4-station interview with each station mapped to attributes relevant to medical school success. Instead of live interviews, applicants recorded 5-minute responses to questions for each station using their own hardware. These responses were later assessed by raters asynchronously. Out of 627 applicants, 232 applicants completed the vMPI. Validity evidence was generated for the vMPI and compared with the MPI on the internal structure, relationship to other variables, and consequential validity, including applicant and interviewer acceptability. Overall, the vMPI demonstrated similar reliability and factor structure to the MPI. As with the MPI, applicant performance was predicted by nonacademic screening tools but not academic measures. Applicants' acceptance of the vMPI was positive. Most interviewers found the vMPI to be acceptable and reported confidence in their ratings. Continuing physical distancing concerns will require multiple options for admissions committees to select medical students. The vMPI is an example of a customized approach that schools can implement and may have advantages for selection beyond the COVID-19 pandemic. Future evaluation will examine additional validity evidence for the tool.

A Virtual Cardiovascular Care Program for Prevention of Heart Failure Readmissions in a Skilled Nursing Facility Population: Retrospective Analysis.

BACKGROUND: Patients with heart failure (HF) in skilled nursing facilities (SNFs) have 30-day hospital readmission rates as high as 43%. A virtual cardiovascular care program, consisting of patient selection, initial televisit, postconsultation care planning, and follow-up televisits, was developed and delivered by Heartbeat Health, Inc., a cardiovascular digital health company, to 11 SNFs (3510 beds) in New York. The impact of this program on the expected SNF 30-day HF readmission rate is unknown, particularly in the COVID-19 era. OBJECTIVE: The aim of the study was to assess whether a virtual cardiovascular care program could reduce the 30-day hospital readmission rate for patients with HF discharged to SNF relative to the expected rate for this population. METHODS: We performed a retrospective case review of SNF patients who received a virtual cardiology consultation between August 2020 and February 2021. Virtual cardiologists conducted 1 or more telemedicine visit via smartphone, tablet, or laptop for cardiac patients identified by a SNF care team. Postconsult care plans were communicated to SNF clinical staff. Patients included in this analysis had a preceding index admission for HF. RESULTS: We observed lower hospital readmission among patients who received 1 or more virtual consultations compared with the expected readmission rate for both cardiac (3% vs 10%, respectively) and all-cause etiologies (18% vs 27%, respectively) in a population of 3510 patients admitted to SNF. A total of 185/3510 patients (5.27%) received virtual cardiovascular care via the Heartbeat Health program, and 40 patients met study inclusion criteria and were analyzed, with 26 (65%) requiring 1 televisit and 14 (35%) requiring more than 1. Cost savings associated with this reduction in readmissions are estimated to be as high as US $860 per patient. CONCLUSIONS: The investigation provides initial evidence for the potential effectiveness and efficiency of virtual and digitally enabled virtual cardiovascular care on 30-day hospital readmissions. Further research is warranted to optimize the use of novel virtual care programs to transform delivery of cardiovascular care to high-risk populations.

Projection of budgetary savings to US state Medicaid programs from reduced nursing home use due to an Alzheimer's disease treatment.

INTRODUCTION: The approval of a disease-modifying Alzheimer's disease (AD) treatment could provide relief to US state budgets that were hit hard by the COVID-19 pandemic, as mostly Medicare would cover treatment cost, whereas Medicaid would see savings from reduced nursing home use. METHODS: We project savings from 2021 to 2040 with a simulation model from the perspective of state Medicaid programs. RESULTS: Assuming a 40% and 22% relative reduction of disease progression rates with treatment, Medicaid would avoid payments of $186.2 and $93.5 billion for around 1.11 and 0.57 million nursing home patient-years, respectively. The savings correspond to a 5.06% and 2.49%, respectively, relative reduction of Medicaid spending on nursing home care. Higher per capita savings were projected for older states, those with higher Medicaid payment rates, those with more nursing home residents covered by Medicaid, and those with a lower federal contribution. DISCUSSION: States stand to realize substantial savings from a potential AD treatment. A state's health system preparedness to handle the large number of patients will influence the actual magnitude of the savings and how fast they will accrue.

Building resilient societies after COVID-19: the case for investing in maternal, neonatal, and child health.

Resilient societies respond rapidly and effectively to health challenges and the associated economic consequences, and adapt to be more responsive to future challenges. Although it is only possible to recognise resilience retrospectively, the COVID-19 pandemic has occurred at a point in human history when, uniquely, sufficient knowledge is available on the early-life determinants of health to indicate clearly that a focus on maternal, neonatal, and child health (MNCH) will promote later resilience. This knowledge offers an unprecedented opportunity to disrupt entrenched strategies and to reinvest in MNCH in the post-COVID-19 so-called new normal. Furthermore, analysis of the short-term, medium-term, and longer-term consequences of previous socioeconomic shocks provides important insights into those domains of MNCH, such as neurocognitive development and nutrition, for which investment will generate the greatest benefit. Such considerations apply to high-income countries (HICs) and low-income and middle-income countries (LMICs). However, implementing appropriate policies in the post-COVID-19 recovery period will be challenging and requires political commitment and public engagement.