On the advantages and disadvantages of virtual continuing medical education: a scoping review.

Introduction: With the COVID-19 pandemic, most continuing medical education activities became virtual (VCME). The authors conducted a scoping review to synthesize the advantages and disadvantages of VCME to establish the impact of this approach on inequities that physicians face along the intersections of gender, race, and location of practice. Methods: Guided by the methodological framework of Arksey and O'Malley, the search included six databases and was limited to studies published between January 1991 to April 2021. Eligible studies included those related to accredited/non-accredited post-certification medical education, conferences, or meetings in a virtual setting focused on physicians. Numeric and inductive thematic analyses were performed. Results: 282 studies were included in the review. Salient advantages identified were convenience, favourable learning formats, collaboration opportunities, effectiveness at improving knowledge and clinical practices, and cost-effectiveness. Prominent disadvantages included technological barriers, poor design, cost, lack of sufficient technological skill, and time. Analysis of the studies showed that VCME was most common in the general/family practice specialty, in suburban settings, and held by countries in the Global North. A minority of studies reported on gender (35%) and race (4%). Discussion: Most studies report advantages of VCME, but disadvantages and barriers exist that are contextual to the location of practice and medical subspecialty. VCME events are largely organized by Global North countries with suboptimized accessibility for Global South attendees. A lack of reported data on gender and race reveals a limited understanding of how VCME affects vulnerable populations, prompting potential future considerations as it evolves.

Introduction: Par suite de la pandémie de la COVID-19, la plupart des activités de formation médicale continue ont été offertes en ligne. Les auteurs ont effectué une revue exploratoire de la littérature visant à faire la synthèse des avantages et des inconvénients de la formation médicale continue en mode virtuel (FMCV) et à évaluer les effets de cette approche sur les inégalités qui affectent les médecins en fonction du sexe, de la race et du lieu d'exercice. Méthodes: Suivant le cadre méthodologique d'Arksey et O'Malley, nous avons effectué une recherche dans six banques de données, que nous avons limitée aux études publiées entre janvier 1991 et avril 2021. Les études incluses étaient celles relatives à la formation médicale post-certification, accréditée ou non, aux conférences et aux réunions destinées aux médecins qui se sont déroulées dans un cadre virtuel. Une analyse numérique et une analyse thématique inductive ont été réalisées. Résultats: Au total, 282 articles ont été inclus dans l'étude. Les principaux avantages identifiés sont la commodité, les formats favorables à l'apprentissage, les possibilités de collaboration, l'efficacité pour l'amélioration des connaissances et des pratiques cliniques et le rapport coût-efficacité. Les principaux inconvénients sont les obstacles technologiques, les défauts de conception, le coût, les compétences technologiques insuffisantes et le manque de temps. L'analyse des études a montré que la FMCV était plus courante dans la spécialité de la médecine générale/familiale, dans les banlieues et dans les pays du Nord. Quelques études prennent en compte sexe (35 %) et race (4 %). Discussion: La plupart des études évoquent les avantages de la FMCV, mais il existe des inconvénients et des obstacles liés au lieu de pratique et à la surspécialité médicale. La plupart des activités de FMCV sont organisées dans les pays du Nord et leur accessibilité n'est pas optimale pour les participants provenant des pays du Sud. Le manque de données sur e sexe et la race des participants limite à notre compréhension de la façon dont la FMCV affecte les populations vulnérables. Ces facteurs seraient à prendre en considération dans les recherches futures sur le sujet au fur et à mesure que la FMCV évolue.

Patient Experiences With a Remote Monitoring Pathway for COVID-19.

INTRODUCTION: Due to the coronavirus disease 2019 (COVID-19) pandemic, a remote monitoring pathway was developed at Michael Garron Hospital to allow individuals with confirmed or presumed COVID-19 infection to successfully manage their illness at home. This study aims to understand patients' experiences on this remote monitoring pathway and to investigate the effectiveness of the pathway in preventing unnecessary emergency department (ED) visits and detecting severe infection. METHODS: A total of 35 semi-structured interviews were conducted over the phone. Researchers reviewed transcripts to come up with an index of nodes. Two researchers initially coded the same four transcripts to ensure high inter-rater reliability. The remaining 31 transcripts were coded by one researcher. RESULTS: Of patients, 80% (n = 28) had a positive experience on the pathway. Remote monitoring was effective in reassuring 22.9% of patients (n = 8) with mild-moderate symptoms that their symptoms were not significant enough to go to the ED and they were monitored at home. A total of 8.6% of patients (n = 3) were correctly identified as having severe symptoms while on the pathway and were asked to present to the hospital. For 8.6% of patients (n = 3), remote monitoring did not identify their severe COVID-19 illness. Of patients, 2.9% (n = 1) were incorrectly identified as having severe COVID-19 symptoms when they were clinically well. DISCUSSION: Remote monitoring is an effective tool to optimize healthcare resources during a pandemic. It reduces ER visits and provides a means for routine follow-up while minimizing virus exposure. Patients generally had a positive experience; however, more research needs to be done on optimizing the detection of severe infection.

Impact of a "Brain Protection Bundle" in Reducing Severe Intraventricular Hemorrhage in Preterm Infants <30 Weeks GA: A Retrospective Single Centre Study.

BACKGROUND: despite advances in perinatal care, periventricular/intraventricular hemorrhage (IVH) continues to remain high in neonatal intensive care units (NICUs) worldwide. Studies have demonstrated the benefits of implementing interventions during the antenatal period, stabilization after birth (golden hour management) and postnatally in the first 72 h to reduce the incidence of IVH. OBJECTIVE: to compare the incidence of severe intraventricular hemorrhage (IVH ≥ Grade III) before and after implementation of a "brain protection bundle" in preterm infants <30 weeks GA. STUDY DESIGN: a pre- and post-implementation retrospective cohort study to compare the incidence of severe IVH following execution of a "brain protection bundle for the first 72 h from 2015 to 2018. Demographics, management practices at birth and in the NICU, cranial ultrasound results and short-term morbidities were compared. RESULTS: a total of 189 and 215 infants were included in the pre- and post-implementation phase, respectively. No difference in the incidence of severe IVH (6.9% vs. 9.8%, p = 0.37) was observed on the first cranial scan performed after 72 h of age. CONCLUSION: the implementation of a "brain protection bundle" was not effective in reducing the incidence of severe IVH within the first 72 h of life in our centre.