Is time really of the essence? Timeliness of narrative feedback in ophthalmology CBME assessments.

PURPOSE: Competency-based medical education relies on a strong program of assessment, and quality comments play a vital role in ensuring its success. The goal of this study is to determine the effect of the timeliness of assessment completion on the quality of the feedback. MATERIALS AND METHODS: Using the Quality of Assessment for Learning (QuAL) score 2478 assessments were evaluated. The assessments included those completed between July 2017 and December 2020 for 18 ophthalmology residents. Spearman correlation, Mann-Whitney U and Kruskal-Wallis tests were used to assess variations in QuAL scores based on the timeliness of assessment completion. RESULTS: The timeliness of assessment completion ranged from 0 to 299 d with the mean time for completion being 3 d. As the delay increased, the QuAL score decreased. Feedback provided 4, 5, and 14 d post-encounter demonstrated statistically significant differences in the QuAL score. Additionally, there was a significant difference in the timeliness of feedback when there is no written comment. CONCLUSIONS: This study demonstrates that the timeliness of assessment completion might have an effect on the quality of written feedback. Written feedback should be completed within 14 d of the encounter to optimize quantity and quality.

Systematic review of simulation-based education in strabismus assessment and management.

BACKGROUND: Strabismus is a dynamic condition for which simulation-based training is valuable, given the variable complexity and relatively reduced exposure compared with other ophthalmic presentations. This study assessed the performance of simulation models available for medical training in the assessment and management of strabismus. METHODS: A systematic review of relevant peer-reviewed academic databases was conducted, without publication date restrictions. English-language publications evaluating the performance of simulation models for education on strabismus were included. Risk of bias was assessed using the Cochrane RoB-2 tool and CLARITY Risk of Bias Instrument for Cross-Sectional Surveys of Attitudes and Practices. Validity of evidence was evaluated using the Kirkpatrick framework. RESULTS: Of the total 3,298 citations exported for title and abstract screening, 54 advanced to full-text screening, and 7 were included in final review. Model types were either dry (2), wet (4), or virtual reality (1). All models were deemed to be successful, but few standardized parameters were specified. Costs of models ranged from a few dollars (ball and wood), to moderate (non-cadaveric), to costly (virtual reality). All studies scored a moderate or high risk of bias, and the majority (4/7) of studies scored level 1 on the Kirkpatrick scale. CONCLUSIONS: Research on simulation for strabismus assessment and management is limited and varied for model fidelity and testing audiences. All models were deemed individually successful compared to non-simulation-based teaching methodologies, although no direct comparisons were made. The limited evidence available suggests that low-fidelity and low-cost models can be used for trainees without sacrificing educational quality.

Family physicians' involvement in palliative cancer care.

BACKGROUND: Family physicians' (FPs) long-term relationships with their oncology patients position them ideally to provide primary palliative care, yet their involvement is variable. We examined perceptions of FP involvement among outpatients receiving palliative care at a cancer center and identified factors associated with this involvement. METHODS: Patients with advanced cancer attending an oncology palliative care clinic (OPCC) completed a 25-item survey. Eligible patients had seen an FP within 5 years. Binary multivariable logistic regression analyses were conducted to identify factors associated with (1) having seen an FP for palliative care within 6 months, and (2) having a scheduled/planned FP appointment. RESULTS: Of 258 patients, 35.2% (89/253) had seen an FP for palliative care within the preceding 6 months, and 51.2% (130/254) had a scheduled/planned FP appointment. Shorter travel time to FP (odds ratio [OR] = 0.67, 95% confidence interval [CI] = 0.48-0.93, p = 0.02), the FP having a 24-h support service (OR = 1.96, 95% CI = 1.02-3.76, p = 0.04), and a positive perception of FP's care (OR = 1.05, 95% CI = 1.01-1.09, p = 0.01) were associated with having seen the FP for palliative care. English as a first language (OR = 2.90, 95% CI = 1.04-8.11, p = 0.04) and greater ease contacting FP after hours (OR = 1.33, 95% CI = 1.08-1.64, p = 0.008) were positively associated, and female sex of patient (OR = 0.51, 95% CI = 0.30-0.87, p = 0.01) and travel time to FP (OR = 0.66, 95% CI = 0.47-0.93, p = 0.02) negatively associated with having a scheduled/planned FP appointment. Number of OPCC visits was not associated with either outcome. CONCLUSION: Most patients had not seen an FP for palliative care. Accessibility, availability, and equity are important factors to consider when planning interventions to encourage and facilitate access to FPs for palliative care.

Development of a cumulative teaching score for tracking surgeon performance in undergraduate medical education

Background: Surgeon educators are important in undergraduate medical education (UME). However, teaching activities are undervalued and under-recognized compared with research, resulting in poorer quantity and quality of surgeon teaching. The purpose of this study was to investigate teaching roles available to surgeons and the amount of effort involved. Methods: A comprehensive review of all possible roles surgeons may take in UME at our institution was assembled. Delphi committee members were asked to evaluate each teaching role on the amount of effort needed per hour. Results were analyzed using descriptive statistics, and a Cronbach α of 0.60 or higher was the threshold to declare consensus. Results: Twenty-five participants, including physicians, residents and medical students, completed the study. Consensus was reached on the amount of effort needed for each teaching role. These values were used to prototype a cumulative teaching score that can be used to qualitatively quantify surgeon teaching. Conclusion: Surgeon teaching is important in UME, but not tracked and thus not valued. To improve the quantity and quality of surgeon teaching in UME, we need to track, reward and recognize surgeon teaching activities. The "effort score" we developed to objectively and transparently qualify teaching was able to determine the relative effort needed for each teaching activity in UME at the University of Toronto. Combining the effort score and time committed to each teaching activity will produce a cumulative teaching score for each instructor.

Contexte: Les chirurgiens formateurs jouent un rôle important pendant les études de premier cycle en médecine. Toutefois, les tâches d'enseignement sont sousévaluées et elles ne sont pas suffisamment reconnues comparativement aux activités de recherche, et cela nuit quantitativement et qualitativement à l'enseignement en chirurgie. Cette étude avait pour but d'analyser les divers rôles assumés par les chirurgiens formateurs et l'effort requis. Méthodes: Nous avons procédé à une revue complète de tous les rôles possibles assumés par les chirurgiens durant les études de premier cycle en médecine dans notre établissement. Les membres d'un comité Delphi ont été invités à évaluer chaque rôle de formateur au plan de l'effort requis par heure. Les résultats ont été analysés à l'aide de statistiques descriptives; et un coefficient α de Cronbach de 0,60 ou plus a servi de seuil consensuel. Résultats: Vingt-cinq participants, dont des médecins, des résidents et des étudiants en médecine, ont participé à l'étude. Un consensus a été atteint pour ce qui est de l'effort requis pour chaque rôle de formateur. Ces valeurs ont servi à élaborer le prototype d'un score cumulatif propre à l'enseignement qui peut être utilisé pour quantifier qualitativement l'enseignement par les chirurgiens. Conclusion: L'enseignement par les chirurgiens est important au premier cycle de la formation en médecine, mais ne fait l'objet ni d'un suivi ni d'une évaluation. Pour améliorer quantitativement et qualitativement l'enseignement en chirurgie au premier cycle, nous devons suivre, récompenser et reconnaître les diverses activités d'enseignement dans cette spécialité. L'« indice d'effort ¼ que nous avons élaboré pour qualifier de manière objective et transparente l'enseignement a permis de déterminer l'effort relatif requis pour chaque activité d'enseignement au premier cycle à l'Université de Toronto. En combinant l'indice d'effort et le temps consacré à chaque activité d'enseignement, on obtient un score cumulatif d'enseignement pour chaque instructeur.