Taking Initiative in Addressing Diversity in Medicine.

The existence of systemic racism in Canadian healthcare, among other determinants including accessible education, available occupation, and affordable housing, contributes to the racial divide in treatment and poor health outcomes for Black communities. Recent promising work has demonstrated patient-physician racial concordance in populations of colour as a potential area of focus for addressing health inequities for diverse communities. The impact of shared cultural experiences and cultural competency leads to mutual respect, trust, and improved communication between patients and physicians guiding their care. This approach is dependent on the availability of physicians of colour and similarly other healthcare providers. The Temerty Faculty of Medicine at the University of Toronto has attempted to address the deficit in its own community through a two-pronged approach: mentorship through the Community of Support (COS) and the Summer Mentorship Program (SMP), and the implementation of the Black Student Application Program (BSAP). These initiatives have significantly increased Black medical student representation and continue to have considerable impact on Black communities in the surrounding area. Through partnerships with community organizations that support the ethos of these programs, the vision of a more culturally diverse physician workforce in Canada has been reinforced. The adoption of similar programs across Canadian medical schools can lead to better representation within medicine and help contribute to a necessary culture shift within the ranks of medical institutions. These are critical steps in laying the foundation for a medical education grounded in equity, excellence, and strength in diversity, and a healthcare system that truly provides patient-centred care.

La présence de racisme systémique dans les services de santé au Canada, qui compte parmi d'autres facteurs déterminants comme l'accès à l'éducation, les professions et les emplois disponibles, et le logement abordable contribue à la division raciale dans la qualité des traitements dispensés et les piètres conditions de santé des communautés noires. Des travaux récents et prometteurs ont démontré qu'une concordance ethnique entre le patient et le médecin dans les populations formées de personnes de couleur pouvait s'avérer un champ d'intervention potentiel pour contrer les injustices en matière de santé touchant diverses communautés. Les expériences et les compétences culturelles partagées engendrent le respect mutuel, la confiance et une meilleure communication entre les patients et les médecins qui leur assurent des soins. Cette approche dépend de la présence de médecins de couleur et d'autres prestataires de soins de santé. La faculté de médecine Temerty de l'Université de Toronto a tenté de combler ce déficit dans sa propre communauté par une approche à deux volets: le mentorat par la communauté de soutien (CDS) et le programme estival de mentorat (PEM), et la mise en œuvre du programme de demandes pour les étudiants noirs (PDÉN). Ces mesures ont largement contribué à augmenter le nombre d'étudiants noirs en médecine et continuent d'exercer un impact considérable sur les communautés noires environnantes. Le partenariat avec les organismes communautaires qui s'alignent avec l'éthos de ces programmes a permis de consolider la vision d'un effectif de médecins plus diversifié sur le plan culturel. L'adoption de programmes similaires dans l'ensemble des facultés de médecine canadiennes peut mener à une meilleure représentation en médecine et contribuer à un changement de culture s'avérant nécessaire au sein des établissements médicaux. Ce sont des jalons indispensables pour jeter les bases d'une formation médicale fondée sur l'égalité, l'excellence et dans laquelle la diversité fait la force; et un système de santé qui fournit véritablement des soins centrés sur le patient.

Early vs Late Surgery for Patients With Endocarditis and Neurological Injury: A Systematic Review and Meta-analysis.

BACKGROUND: Surgical timing in infective endocarditis (IE) with preoperative neurological events remains controversial. The relevant society guidelines are each on the basis of a small number of observational studies. This meta-analysis was designed to search the available literature broadly and assess the weight of available evidence as comprehensively as possible. METHODS: We searched MEDLINE and EMBASE to April 2018 for studies that compared mortality or neurological exacerbation in early vs late surgery for IE complicated by neurological events. Random effects meta-analysis was performed. RESULTS: Twenty-seven observational studies (25 unadjusted, n = 879; 2 adjusted, n = 451) met inclusion criteria. Using early and late thresholds defined in each study (7 or 14 days), early surgery in ischemic or hemorrhagic stroke was associated with elevated perioperative mortality vs late surgery (pooled relative risk [RR], 1.74; 95% confidence interval, 1.34-2.25; P < 0.0001; I2 = 0%) and greater neurological exacerbation (RR, 2.09; 95% confidence interval, 1.32-3.32; P = 0.002; I2 = 33%). In subgroup analysis, for ischemic stroke, early surgery before 7 vs before 14 days exhibited similar perioperative mortality and neurological exacerbation. For hemorrhagic stroke, performing surgery before 21 vs before 28 days showed trends toward perioperative mortality (RR, 1.77 vs 0.63, interaction P = 0.14) and neurological (RR, 2.02 vs RR, 0.44; interaction P = 0.11) exacerbation. There was no difference in long-term mortality but reporting was sparse. Early surgery was often performed for clinical deterioration, negatively biasing outcomes. CONCLUSIONS: Available observational data support delaying surgery by 7-14 days if possible in IE complicated by ischemic stroke and > 21 days in hemorrhagic stroke to decrease perioperative mortality and neurological exacerbation rates. Randomized trials are needed for definitive guidance.

Effort and trust: the underpinnings of active learning.

Three undergraduate students and their teacher discuss two crucial issues that form the implicit basis of active learning: effort and trust. They use a single course in a Health Sciences Program to anchor their comments.