Medical Students' Perception of Telesimulation Training: A Qualitative Analysis.

OBJECTIVES: Over the past 2 decades, simulation-based learning has become an essential part of medical training. Simulated clinics have proven to be effective for training medical students. Even so, this learning method presents organizational and financial challenges that limit its dissemination to all medical students, especially since the COVID-19 pandemic. Simulated teleconsultation retains the advantages of interactive simulated clinics while offering concrete solutions to the challenges faced. The project aims to explore students' perspectives on simulated teleconsultation training compared to simulated clinics in person. METHODS: Ten pre-clerkship students in the Faculty of Medicine at the University of Ottawa participated in interviews following in-person and teleconsultation simulated clinic sessions. The interview guide was developed based on previous work. The questions asked concerned experience with teleconsultation, interaction with the tutor and patient, practical or logistical obstacles, educational value and feasibility. The authors evaluated the results using a thematic analysis. RESULTS: The interview analysis showed that the tutor feedback received during the simulated teleconsultation was comparable to that received after the in-person simulated clinic. Although most of the students enjoy teleconsultation, they raised the challenge of carrying out physical examinations and creating a personal connection with the tutor/patient. CONCLUSION: Given the circumstances of the pandemic and students' comfort with technology, the new generation of medical students seems prepared to embrace teleconsultation. The themes identified in the analysis will enable the necessary adjustments to be made in order to optimize their teleconsultation training, an inextricable step in promoting the active offer of healthcare services.

Evaluation of a tool to improve the quality of preceptor written feedback for family medicine residents: training and use of a CanMEDS-MF competency-based criterion guide.

Background: Written feedback is essential in resident teaching, but preceptors are not always well equipped to provide relevant feedback. The purpose of this study was to evaluate the effectiveness of multi-episodic training and the use of a criterion-referenced guide for written feedback for family medicine preceptors in a French-language academic hospital. Method: Twenty-three (23) preceptors participated in the training and used the criterion-referenced guide to guide them during the written evaluation in an evaluation sheet named "Field Notes." The content of these Field Notes was analyzed according to completion, the rate of specific feedback, and the rate of feedback by CanMEDS-MF role before and after the training over a three-month period. Results: Based on the analysis of the Field Notes (n = 70 pre-test; n = 138 post-test), an increase in the percentage of completion (50% vs. 92%, z = 2.97, p = 0.0030) and specific feedback (59% vs. 92%, z = 2.47, p=0.0137) was noted. There was no significant increase in feedback by CanMEDS-MF role. Conclusions: The development of multi-episodic training and a criterion-referenced guide, created according to the CanMEDS-MF repository, suggests an improvement in comprehensive and specific written feedback in family medicine education.

Contexte: La rétroaction écrite est primordiale dans l'enseignement aux résidents, mais les précepteurs ne sont pas toujours outillés pour offrir une rétroaction pertinente. Cette étude visait à évaluer l'efficacité de formations multiépisodiques et l'utilisation d'un guide critérié pour les rétroactions écrites des précepteurs en médecine familiale d'un centre hospitalier académique francophone. Méthode: Vingt-trois (23) précepteurs ont participé aux formations et ont utilisé le guide critérié pour les guider lors de l'évaluation écrite dans une fiche évaluative nommée «feuille de route¼. Le contenu de ces feuilles de route a été analysé selon la complétion, le taux de rétroactions spécifiques et le taux de rétroactions par rôle CanMEDS-MF avant et après les formations sur une période de trois mois. Résultats: Selon l'analyse des feuilles de route (n=70 prétest ; n=138 posttest), une augmentation du pourcentage de complétion (40% vs 92%, z=3.51, p=0.0005) et de rétroactions spécifiques (59% vs 92%, z=2.47, p=0.0137) fut notée. Il n'y avait aucune augmentation significative quant aux rétroactions par rôle CanMEDS-MF. Conclusions: L'élaboration de formations multiépisodiques et d'un guide critérié, créés selon le référentiel CanMEDS-MF, suggère une amélioration de rétroactions écrites complètes et spécifiques en éducation de la médecine familiale.

Communicating effectively with patients about vaccination: A systematic review of randomized controlled trials.

Background: Good communication between healthcare professionals and their patients is essential to enlighten the benefits and risks of vaccination. Despite the availability of effective vaccines, reluctance prevails, sometimes fuelled by sub-optimal communication leading to a lack of trust. An evaluation of the effectiveness of a communication strategy for which healthcare professionals are trained has yet to be carried out. Objective: Systematic review of studies with a randomized controlled trial (RCT) to define and evaluate the impact of healthcare professionals' communication on patients' vaccine adherence. Methods: We performed a structured search on Medline, Embase, CENTRAL, PsycINFO and CINAHL. The studies selected include those involving healthcare professionals authorized to administer vaccines according to Canadian guidelines. Primary outcomes include vaccination rate or vaccine hesitancy rate. Results: Nine articles were included. Five studies (n=5) reported intervention effectiveness according to vaccine adherence. The results are largely represented by parental vaccine hesitancy for human papillomavirus (HPV) or childhood vaccination, while three studies (n=3) target the general population. The risk of bias relative to the studies is either low (n=7) or of some concern (n=2). Conclusion: The effectiveness of communication varies according to the studies and knowledge acquired through training. Future studies will need to examine communication with healthcare professionals in order to establish a consensus on optimal and appropriate training.

Portrait of French-speaking minorities with respect to vaccination against COVID-19.

Background: The coronavirus disease 2019 (COVID-19) vaccination campaign highlighted the requirement to better understand the needs of different populations. French-speaking minorities (FSMs) have greater difficulty accessing quality care in French, and this problem was exacerbated during the COVID-19 pandemic. Objective: The aim of this survey was to develop a descriptive portrait of the health needs of FSMs in relation to the COVID-19 vaccination campaign by describing their vaccination status, attitudes and beliefs compared with English-speaking majorities. Methods: A survey was conducted among eligible participants using convenience sampling. Data measurement includes a descriptive statistical comparison using analysis of the variance, univariate logistic regressions and a two-proportions z-test. Results: Of the 1,505 respondents (554 FSMs vs. 951 English speakers), the FSMs have an average age of 51.4 years and 89.2% are Canadian citizens. Vaccination of children was preponderant among English speakers (74.2% vs. 86.3%), including against COVID-19 (58.6% vs. 73.9%). A higher proportion of FSMs had gotten vaccinated in order to obtain a vaccine passport (39% vs. 29.3%). Among the unvaccinated, FSMs were more likely to question the efficacy of vaccines (60% vs. 36.4%). Canadian citizen FSMs with higher education could be divided in relation to the vaccine regimen. Conclusion: This survey revealed differences between FSMs and the English-speaking majority in their perceptions of vaccine efficacy, particularly vaccination of children, and a polarization of attitudes/beliefs among FSMs according to certain sociodemographic factors.

The quest for greater equity: a national cross-sectional study of the experiences of Black Canadian medical students.

BACKGROUND: Black medical students have been consistently underrepresented in Canadian medical schools, and data on the impact of discrimination on their medical education remain limited. In this cross-sectional study, we aimed to investigate the experiences of Black medical students through the Black Medical Students' Association of Canada (BMSAC). METHODS: We developed a 63-item instrument around the domains of inclusion and diversity, wellness, discrimination, career advancement and diversity in medical education. The anonymous web-based questionnaire was sent to 128 medical students and first-year residents from all 17 Canadian medical schools via the BMSAC listserv. We obtained frequencies for demographic data and self-reported experiences. RESULTS: We received 52 responses. Of respondents, 59% had at least 1 personal encounter with discrimination in medical school. Discrimination was experienced in both clinical and academic contexts, notably from patients, peers and hospital staff. Students further along in their medical training were more likely to endorse having experienced discrimination in medical school. Most respondents had positive experiences with academic and clinical inclusion, as well as resiliency in the face of discrimination. However, most respondents had negative experiences relating to reporting discrimination, their well-being, career advancement, sentiments of minority tax and low diversity in medical education. INTERPRETATION: We found that discrimination has important implications on the learning experiences of Black medical students surveyed from the BMSAC. This directly challenges the notion that Canadian medical schools are impervious to racism and highlights the need for advocacy and systemic changes to eliminate institutional racism.

Nomenclature of real patients in health professional education by role and engagement: a narrative literature review.

Research problem: Real patients living with a disease and engaged in the education of healthcare professionals are referred to by different terms. To address this, A.Towle proposed a draft taxonomy. Objective: Our objective is to extract from the literature the definitions given for the following terms: (1) patient educator, (2) patient instructor, (3) patient mentor, (4) partner patient, (5) patient teacher, (6) Volunteer Patient in order to clearly identify their roles and level of engagement. Methods: The literature search was carried out in Medline, CINAHL, PsychInfo and Eric by adding medical education or healthcare professional to our previously identified keywords to ensure that it is indeed literature dealing with real patients' involvement in the education of healthcare professionals. Results: Certain terms refer to real and simulated patients. Roles are more or less well described but may refer to multiple terms. The notion of engagement is discussed, but not specifically. Conclusion: Explicitly defining the terms used according to the task descriptions and level of engagement would help contribute to Towle's taxonomy. Real patients would thus feel more legitimately involved in health professional education.

Problème de recherche: Les patients vivant avec une maladie et qui sont impliqués dans l'éducation des professionnels de la santé sont désignés par des termes différents. Pour y remédier, A.Towle a proposé un projet de taxonomie. Objectif: Notre objectif est d'extraire de la littérature les définitions données pour les termes suivants : (1) patient éducateur, (2) patient instructeur, (3) patient mentor, (4) patient partenaire, (5) patient enseignant, (6) patient volontaire afin d'identifier clairement leurs rôles et leur niveau d'implication. Méthodes: La recherche documentaire a été effectuée dans Medline, CINAHL, PsychInfo et Eric en ajoutant l'éducation médicale ou le professionnel de santé à nos mots-clés précédemment identifiés afin de s'assurer qu'il s'agit bien de littérature traitant de l'implication des patients dans l'éducation des professionnels de santé. Résultats: Certains termes font référence à des patients ayant une maladie ou simulés. Les rôles sont plus ou moins bien décrits mais peuvent faire référence à plusieurs termes. La notion d'implication est abordée, mais pas de manière spécifique. Conclusion: Définir explicitement les termes utilisés en fonction de la description des tâches et du niveau d'implication permettrait de contribuer à la taxonomie de Towle. Les patients se sentiraient ainsi plus légitimement impliqués dans la formation des professionnels de santé.

Preclerkship Point-of-Care Ultrasound: Image Acquisition and Clinical Transferability.

INTRODUCTION: The integration of point-of-care ultrasound (POCUS) in preclerkship medical education is currently popular and based on the notion that POCUS may improve diagnostic and procedural skills in medical students. However, empirical evidence demonstrating that POCUS can enhance clinical skills in preclerkship students has been lacking. We sought to evaluate anatomical sonographic knowledge and ultrasound generation capabilities associated with the implementation of a 3-h echocardiography training camp led by 2 emergency physicians and using a flipped classroom design. METHODS: Preclerkship students from the University of Ottawa (n = 32) were recruited to participate. A flipped classroom model was adopted, providing students with a 3-chaptered peer-designed, expert validated ultrasound manual before the workshop, to maximize scanning times (2 h of reading). A pretest Likert-type design was used to assess student perception of the ultrasound tool. Similarly, a pretest/post-test model was used to assess sonographic anatomical identification. In addition, a subsequent Objective Structured Clinical Examination (OSCE) test was done 3 weeks after the hands-on session, to evaluate image generation (4 cardiac views: parasternal long, parasternal short, subxiphoid, and apical 4 chambers), understanding of knobology and structural labeling. RESULTS: For the sonographic anatomy, there was a statistically significant increase (P < .001) between pretest (average = 12.12) and post-test (average = 18.85). The OSCE, which also ascertained knowledge retention, found that 81% of students were able to generate all 4 cardiac views perfectly, 6% were able to obtain 3 views, 10% obtained 2 views and 3% successfully generated a single view. The most challenging scan to generate was the apical 4-chamber view. CONCLUSION: The positive outcomes stemming from this study reinforces the notion that formal curricular integration of POCUS at the preclerkship level has tangible benefits for medical students.

[Prevalence of major depression in the arthritic conditions of Canadian populations: a comparative study between English-speaking majority and francophones in minority communities]. / Prévalence de la dépression majeure chez les arthritiques des populations canadiennes : étude comparative entre anglophones majoritaires et francophones en situation linguistique minoritaire.

OBJECTIVE: Mental health and arthritis have been recognized as major public health issues. Francophone minority status has now been acknowledged as a health determinant. The objective of this study was to determine the prevalence of major depression among adults with arthritis in Francophone minority populations compared to the Anglophone majority. METHODS: Secondary analysis of the CCHS (merger of 2003 (cycle 2.1), 2005 (Cycle 3.1), 2007 (cycle 4.1), 2008 and 2009) excluding Quebec residents. The language variable was constructed using an existing algorithm which combines maternal tongue, language of conversation, language of interview, and preferred language. Major depression was defined according to the DSM IV. Presence or absence of arthritis was a self-reported variable. The prevalence and odds ratios for depression in people with arthritis were calculated and adjusted for various factors (socio-economic, social isolation, access to health services). RESULTS: The study identified 159,426 Anglophones and 10,658 Francophones. Among the participants with arthritis (27%), the prevalence of depression in Francophones and Anglophones was 8.5% and 8.4%, respectively. In men, Anglophones were more at risk for depression than Francophones: OR 2.36 (95% CI: 2.07-2.70) vs. OR 1.87 (95% CI: 1.20-2.91). This trend was not observed in women. CONCLUSION: In our sample of people with arthritis, depression seems to affect more particularly the English-speaking men, however given the small sample size, we need to be cautious in our conclusions.