Incorporating a situational judgement test in residency selections: clinical, educational and organizational outcomes.

BACKGROUND: Computer-based assessment for sampling personal characteristics (Casper), an online situational judgement test, is a broad measure of personal and professional qualities. We examined the impact of Casper in the residency selection process on professionalism concerns, learning interventions and resource utilization at an institution. METHODS: In 2022, admissions data and information in the files of residents in difficulty (over three years pre- and post- Casper implementation) was used to determine the number of residents in difficulty, CanMEDS roles requiring a learning intervention, types of learning interventions (informal learning plans vs. formal remediation or probation), and impact on the utilization of institutional resource (costs and time). Professionalism concerns were mapped to the 4I domains of a professionalism framework, and their severity was considered in mild, moderate, and major categories. Descriptive statistics and between group comparisons were used for quantitative data. RESULTS: In the pre- and post- Casper cohorts the number of residents in difficulty (16 vs. 15) and the number of learning interventions (18 vs. 16) were similar. Professionalism concerns as an outcome measure decreased by 35% from 12/16 to 6/15 (p < 0.05), were reduced in all 4I domains (involvement, integrity, interaction, introspection) and in their severity. Formal learning interventions (15 vs. 5) and informal learning plans (3 vs. 11) were significantly different in the pre- and post-Casper cohorts respectively (p < 0.05). This reduction in formal learning interventions was associated with a 96% reduction in costs f(rom hundreds to tens of thousands of dollars and a reduction in time for learning interventions (from years to months). CONCLUSIONS: Justifiable from multiple stakeholder perspectives, use of an SJT (Casper) improves a clinical performance measure (professionalism concerns) and permits the institution to redirect its limited resources (cost savings and time) to enhance institutional endeavors and improve learner well-being and quality of programs.

Optimization of Low-Tech Protected Structure and Irrigation Regime for Cucumber Production under Hot Arid Regions of India.

Water scarcity and climate variability impede the realization of satisfactory vegetable yields in arid regions. It is imperative to delve into high-productivity and water-use-efficient protected cultivation systems for the sustained supply of vegetables in harsh arid climates. A strenuous effort was made to find suitable protected structures and levels of irrigation for greenhouse cucumber production in hot arid zones of India. In this endeavor, the effects of three low-tech passively ventilated protected structures, i.e., naturally ventilated polyhouse (NVP), insect-proof screenhouse (IPS) and shade screenhouse (SHS), as well as three levels of irrigation (100%, 80% and 60% of evapotranspiration, ET) were assessed for different morpho-physiological, yield and quality traits of the cucumber in a two-year study. Among the low-tech protected structures, NVP was found superior to IPS and SHS for cucumber performance, as evidenced by distinctly higher fruit yields (i.e., 31% and 121%, respectively) arising as a result of higher fruit number/plants and mean fruit weights under NVP. The fruit yield decreased in response to the degree of water shortage in deficit irrigation across all protected structures. However, the interaction effect of the protected structure and irrigation regime reveals that plants grown under moderate deficit (MD, 20% deficit) inside NVP could provide higher yields than those obtained under well-watered (WW, 100% of ET) conditions inside IPS or SHS. Plant growth indices such as vine length, node number/plant, and shoot dry mass were also measured higher under NVP. The greater performance of cucumber under NVP was attributed to a better plant physiological status (i.e., higher photosystem II efficiency, leaf relative water content and lower leaf water potential). The water deficit increased water productivity progressively with its severity; it remained higher in NVP, as reflected by 20% and 94% higher water productivity than those recorded in IPS and SHS, respectively, across different irrigation levels. With the exception of total soluble solids and fruit dry matter content (which were recorded higher), fruit quality parameters were reduced under water deficit conditions. The findings of this study emphasize the importance of considering suitable low-tech protected structures (i.e., NVP) and irrigation levels (i.e., normal rates for higher yields and moderate deficit (-20%) for satisfactory yields) for cucumber in hot arid regions. The results provide valuable insights for growers as well as researchers aiming to increase vegetable production under harsh climates and the water-limiting conditions of arid regions.

A Prospective Comparison of Octyl-2-Cyanoacrylate and Suture in Facial Wounds.

The study aimed to evaluate the efficacy of octyl-2-cyanoacrylate as well as sutures as a wound closure material. Whether octyl-2-cyanoacrylate can be used as an alternative to suture in the closure of facial wounds. Out of total of 19 wounds, 11 wounds were closed with sutures and tissue adhesive both, out of rest 8 wounds, 4 wounds were closed using sutures alone and in 4 wounds, closure was done with tissue adhesive alone. Therefore, a total of 15 facial wounds were divided into two groups: Group-I Cases in whom 3-0 Black silk suture was used for closure of the wound and Group-II Cases in whom Dermabond (Octyl-2-Cyanoacrylate) was used for closure of the wound. Results showed that Octyl-2-cyanoacrylate offered the benefit of decreased procedure time with less pain, no need for its removal, and better cosmetic outcome compared to sutures.

A framework for residents' pursuit of excellence based upon non-cognitive and cognitive attributes.

PURPOSE: Excellence, although variably conceptualized, is commonly used in medicine and the resident excellence literature is limited. Both cognitive attributes (CAs) and non-cognitive attributes (NCAs) are essential for academic and clinical performance; however, the latter are difficult to evaluate. Undergirded by an inclusive and non-competitive approach and utilizing CAs and NCAs, we propose a criterion-referenced behavioral framework of resident excellence. METHODS: Perceptions of multiple stakeholders (educational administrators, faculty, and residents), gathered by survey (n = 218), document analysis (n = 52), and focus group (n = 23), were analyzed. Inductive thematic analysis was followed by deductive interpretation and categorization using sensitizing concepts for excellence, NCAs, and CAs. Chi-squared tests were used to determine stakeholder perception differences. RESULTS: All stakeholders had similar perceptions (P > .05) and 13 behavioral attributes in 6 themes undergirded by insight and conscientiousness were identified. The NCAs included: interpersonal skills (works with others, available, humble), professional (compassionate, trustworthy), commitment to profession (visible, volunteers), commitment to learn (proactively seeks feedback, creates learning opportunities), and work-life balance/integration (calm demeanor, inspirational). The CA (medical knowledge and intellect) included: applies knowledge to gain expertise and improves program's caliber. CONCLUSION: Resident excellence is posited as a pursuit. The attributes are non-competitive, inclusionary, potentially achievable by all, and do not negatively affect freedom of choice. However, contextual and cultural differences are likely and these need validation across societal equity segments. There are implications for learners (adaptive reflection and learning goal orientation), faculty (reduced bias and whole-person feedback), and system leaders (enhancing culture and learning environments) to foster excellence.

Integrative Effect of Protective Structures and Irrigation Levels on Tomato Performance in Indian Hot-Arid Region.

Protected cultivation is gaining momentum in (semi) arid regions to ameliorate the adverse environmental impacts on vegetable crops, besides ensuring high resource use efficiency in resource-limiting environments. Among the less techno-intensive protected cultivation structures, naturally ventilated polyhouses (NVP), insect-proof net houses (IPN) and shade net houses (SNH) are commercial structures in India. With the aim to find the best-protected structure, together with optimum irrigation level, for high yield and water productivity of the tomato crop, the most popular crop in hot arid regions, we evaluated tomato performance in low-tech protected structures (NVP, IPN and SNH) in interaction with three irrigation levels (100, 80 and 60% of crop evapotranspiration, ETc) during spring-summer of 2019 and 2020. The NVP was found superior to both the net house structures (IPN and SNH) for different performance indicators of tomatoes under investigation. The components of plant growth (leaf and stem dry mass) and fruit yield (fruit size, weight, yield), as well as fruit quality (total soluble solids, fruit dry matter and lycopene content) were higher in NVP, regardless of irrigation level. The yield as well as water productivity were significantly higher in NVP at 100% ETc. However, there was no statistical variation for water productivity between NVP and IPN. Microclimate parameters (temperature, relative humidity and photosynthetic active radiation) were markedly more congenial for tomato cultivation in NVP followed by IPN in relation to SNH. Consequently, plants' physiological functioning with higher leaf relative water content (RWC) and lower leaf water potential concomitantly with better photosynthetic efficiency (chlorophyll fluorescence, Fv/Fm), was in NVP and IPN. Most growth and yield attributes were depressed with the decrease in water application rates; hence, deficit irrigation in these low-tech protected structures is not feasible. For tomato cultivation in resource-scarce arid regions, the combination of the normal rate of irrigation (100% ETc) and NVP was optimal for gaining high yield as well as water productivity as compared to net houses.

Reduced CREB3L1 expression in triple negative and luminal a breast cancer cells contributes to enhanced cell migration, anchorage-independent growth and metastasis.

Women with metastatic breast cancer have a disheartening 5-year survival rate of only 28%. CREB3L1 (cAMP-responsive element binding protein 3 like 1) is a metastasis suppressor that functions as a transcription factor, and in an estrogen-dependent model of rat breast cancer, it repressed the expression of genes that promote breast cancer progression and metastasis. In this report, we set out to determine the expression level of CREB3L1 across different human breast cancer subtypes and determine whether CREB3L1 functions as a metastasis suppressor, particularly in triple negative breast cancers (TNBCs). CREB3L1 expression was generally increased in luminal A, luminal B and HER2 breast cancers, but significantly reduced in a high proportion (75%) of TNBCs. Two luminal A (HCC1428, T47D) and two basal TNBC (HCC1806, HCC70) CREB3L1-deficient breast cancer cell lines were characterized as compared to their corresponding HA-CREB3L1-expressing counterparts. HA-CREB3L1 expression significantly reduced both cell migration and anchorage-independent growth in soft agar but had no impact on cell proliferation rates as compared to the CREB3L1-deficient parental cell lines. Restoration of CREB3L1 expression in HCC1806 cells was also sufficient to reduce mammary fat pad tumor formation and lung metastases in mouse xenograft models of breast cancer as compared to the parental HCC1806 cells. These results strongly support a metastasis suppressor role for CREB3L1 in human luminal A and TNBCs. Further, the ability to identify the subset of luminal A (7%) and TNBCs (75%) that are CREB3L1-deficient provides opportunities to stratify patients that would benefit from additional treatments to treat their more metastatic disease.

Evaluation of Crestal Bone Loss in Flap vs Flapless Implant Placement Technique: An In Vivo Comparative Study.

AIMS: The aims of the study were to assess the technique with-flap and flapless implant placement and to compare crestal bone heights around the implant in flapless and conventional flap technique using digital radiovisiograph, in 3 and 6 months after the surgery. MATERIALS AND METHODS: A total of 20 implants were placed by flap and flapless implant technique; each patient received two implants, except for two patients who received four implants. A radiovisiograph was taken at implant placement, as well as 3- and 6-month intervals. Crestal bone level was compared between flapless and flap during these intervals and compared between intervals for each group. RESULTS: On evaluating the distribution, it was found to be asymmetric and hence lacked normality (K-S = 0.382; p <0.001). On mesial side, bone loss values in group I ranged from 0.40 to 1.10 units with a mean value of 0.71 and a standard deviation of 0.26 units. The median value was 0.70. On evaluating the data for normality, it was found to be symmetric and normal (K-S = 0.166; p = 0.200). CONCLUSION: This study concluded that there are not any significant differences in the crestal bone with both flap and flapless techniques. Comparatively, the flapless approach showed a lesser crestal bone height reduction, which was statistically significant. CLINICAL SIGNIFICANCE: Implant dentistry is nonetheless behind when advances are concerned, we have seen the inclination toward minimal invasive implant techniques to yield better esthetic as well as improved results, thus taking care of patients' discomfort.

Experiences and challenges in accessing hospitalization in a government-funded health insurance scheme: Evidence from early implementation of Pradhan Mantri Jan Aarogya Yojana (PM-JAY) in India.

INTRODUCTION: Government-sponsored health insurance schemes can play an important role in improving the reach of healthcare services. Launched in 2018 in India, Pradhan Mantri Jan Aarogya Yojana (PM-JAY) is one of the world's largest government-sponsored health insurance schemes. The objective of this study is to understand beneficiaries' experience of availing healthcare services at the empaneled hospitals in PM-JAY. This study examines the responsiveness of PM-JAY by measuring the prompt attention in service delivery, and access to information by the beneficiaries; financial burden experienced by the beneficiaries; and beneficiary's satisfaction with the experience of hospitalization under PMJAY and its determinants. METHODS: The study was conducted during March-August 2019. Data were obtained through a survey conducted with 200 PM-JAY beneficiaries (or their caregivers) in the Indian states of Gujarat and Madhya Pradesh. The study population comprised of patients who received healthcare services at 14 study hospitals in April 2019. Prompt attention was measured in the form of a) effectiveness of helpdesk, and b) time taken at different stages of hospitalization and discharge events. Access to information by the beneficiaries was measured using the frequency and purpose of text messages and phone calls from the scheme authorities to the beneficiaries. The financial burden was measured in terms of the incidence and magnitude of out-of-pocket payments made by the beneficiaries separate from the cashless payment provided to hospitals by PMJAY. Beneficiaries' satisfaction was measured on a five-point Likert scale. RESULTS: Socio-economically weaker sections of the society are availing healthcare services under PM-JAY. In Gujarat, the majority of the beneficiaries were made aware of the scheme by the government official channels. In Madhya Pradesh, the majority of the beneficiaries got to know about the scheme from informal sources. For most of the elements of prompt attention, access to information, and beneficiaries' satisfaction, hospitals in Gujarat performed significantly better than the hospitals in Madhya Pradesh. Similarly, for most of the elements of prompt attention, access to information, and beneficiaries' satisfaction, public hospitals performed significantly better than private hospitals. Incidence and magnitude of out-of-pocket payments were significantly higher in Madhya Pradesh as compared to Gujarat, and in private hospitals as compared to the public hospitals. CONCLUSION: There is a need to focus on Information, Education, and Communication (IEC) activities for PM-JAY, especially in Madhya Pradesh. Capacity-building efforts need to be prioritized for private hospitals as compared to public hospitals, and for Madhya Pradesh as compared to Gujarat. There is a need to focus on enhancing the responsiveness of the scheme, and timely exchange of information with beneficiaries. There is also an urgent need for measures aimed at reducing the out-of-pocket payments made by the beneficiaries.

Improving hospital-based processes for effective implementation of Government funded health insurance schemes: evidence from early implementation of PM-JAY in India.

BACKGROUND: Government-sponsored health insurance schemes (GSHIS) aim to improve access to and utilization of healthcare services and offer financial protection to the population. India's Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) is one such GSHIS. This paper aims to understand how the processes put in place to manage hospital-based transactions, from the time a beneficiary arrives at the hospital to discharge are being implemented in PM-JAY and how to improve them to strengthen the scheme's operation. METHODS: Guidelines were reviewed for the processes associated with hospital-based transactions, namely, beneficiary authentication, treatment package selection, preauthorization, discharge, and claims payments. Across 14 hospitals in Gujarat and Madhya Pradesh states, the above-mentioned processes were observed, and using a semi-structured interview guide fifty-three respondents were interviewed. The study was carried out from March 2019 to August 2019. RESULTS: Average turn-around time for claim reimbursement is two to six times higher than that proposed in guidelines and tender. As opposed to the guidelines, beneficiaries are incurring out-of-pocket expenditure while availing healthcare services. The training provided to the front-line workers is software-centric. Hospital-based processes are relatively more efficient in hospitals where frontline workers have a medical/paramedical/managerial background. CONCLUSIONS: There is a need to broaden capacity-building efforts from enabling frontline staff to operate the scheme's IT platform to developing the technical, managerial, and leadership skills required for them. At the hospital level, an empowered frontline worker is the key to efficient hospital-based processes. There is a need to streamline back-end processes to eliminate the causes for delay in the processing of claim payment requests. For policymakers, the most important and urgent need is to reduce out-of-pocket expenses. To that end, there is a need to both revisit and streamline the existing guidelines and ensure adherence to the guidelines.

Predictive biomarkers of cardiovascular disease in adult Canadian population.

BACKGROUND: Elevated levels of the enzymes gamma-glutamyltransferase (GGT), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and C-reactive protein (CRP) have been shown to be associated with increased risk of cardiovascular disease (CVD). Objective: To assess cross-sectional relationships between biomarkers GGT, ALT, AST, ALP and CVD in adult Canadian population. METHODS: The Canadian Health Measures Surveys (CHMSs) are a series of cross-sectional national surveys and collect information on indicators of general health and wellness of Canadians. The CHMS has four components. We used data from the first three components (for Study participants ≥ 20 years) from CHMS cycles 1 through 5. RESULTS: Multivariable logistic regression revealed: immigration status [Odds ratio (OR)(95% Confidence Interval (95% CI)) = 0.67 (0.53-0.85), reference category (RC)-no-immigrant] education [1.38(1.10-1.75), RC- > secondary education]; smoking status [ex-smokers: 1.16(0.89-1.51); current smokers: 1.41(0.98-2.05), RC-non-smoker]; and income [middle income: 0.69(0.43-1.10); high income: 0.49(0.29-0.83); RC-lower income] were significantly associated with CVD prevalence. CONCLUSION: The relationship of GGT with CVD prevalence changed among age groups and body mass index categories; was different for males and females; and diabetes was an effect modifier in the relationship between AST and CVD prevalence. Socio-economic factors were significantly associated with CVD prevalence.

Challenges and success strategies for dyad leadership model in healthcare.

The use of a dyad leadership model involving a physician co-leader and a co-leader with a different background, the dyad co-leader, is gradually increasing in Healthcare Organizations (HCOs). There is a paucity of empirical studies on various aspects of this model. This study's aim was to identify challenges and strategies for success in the dyad leadership model in healthcare. Through a mixed-methods approach utilizing focus groups, surveys, and semi-structured interviews, perceptions of 37 leaders in one HCO at different hierarchical levels were analysed based on their lived experiences. The challenges and success strategies spanned personal, interpersonal, and organizational domains. The areas requiring attention included mindsets, competencies, interpersonal relationship, support, time, communication, and collaboration. In addition, the importance of organizational context addressing its structure, strategy, operations, and culture was highlighted. The findings from this study may be used for praxis, development, and implementation of dyad leadership.

Assessment of Tobacco Control Policy in India: An Evaluation using the World Health Organization MPOWER Framework.

BACKGROUND: Tobacco consumption is considered to be one of the most avertable causes of premature mortality and morbidity. In 2004, the World Health Organization (WHO) successfully negotiated the Framework Convention on Tobacco Control to work toward reducing tobacco consumption globally. Being a signatory, India has implemented several programs to control tobacco consumption. OBJECTIVES: The objective of this study is to understand the efficacy of tobacco control policies in India between 2013 and 2019 based on the WHO MPOWER measures. MATERIALS AND METHODS: Secondary data from WHO's reports on the global tobacco epidemic program for the years 2013, 2015, 2017, and 2019 is used. Evaluation of tobacco control policies is done using the MPOWER measures proposed by the WHO in 2008, and a checklist of indicators and scoring system which is widely used in literature. RESULTS: Of the total score of 37, scores for 2013, 2015, 2017, and 2019 are 24, 27, 28, and 29, respectively. The average score for seven years is 27. CONCLUSIONS: Tobacco control policies in India have shown an overall improvement. Achievements have been made even though several implementations related challenges requiring urgent attention persist.

Treatment of extraoral submental sinus tract associated with large periapical lesion of traumatized lower central incisors teeth by periapical surgery and demineralized freeze-dried bone allograft.

The purpose of present case report was to observe the effect of demineralized freeze-dried bone allograft (DFDBA) when combined with periapical surgery for the treatment of extraoral submental sinus tract associated with large periapical lesion of traumatized lower central incisors teeth. A patient complains of extraoral submental draining sinus tract since 6 months due to trauma of lower central incisors teeth 1 year back. Radiographical investigation showed large periapical lesion associated with lower central incisors teeth. The patient was planned for treatment by periapical surgery and DFDBA. The treatment process includes elevation of full-thickness flap, debridement of periapical lesion, root canal treatment, defect fill with DFDBA, and suturing of full-thickness flap at its original position. Complete resolution of extraoral submental sinus tract was achieved after 1 week, and periapical lesion was repaired after 1 year. Thus, DFDBA was effective for the treatment of extraoral submental sinus tract associated with large periapical lesion of traumatized lower central incisors teeth.

Challenges, success factors and pitfalls: implementation of distributed medical education.

OBJECTIVES: There are only a few descriptive reports on the implementation of distributed medical education (DME) and these provide accounts of successful implementation from the senior leadership perspective. In Saskatchewan, over a period of 4 years (2010-2014), four family medicine residency sites were established and two additional sites could not be developed. The aim of this study was to identify challenges, success factors and pitfalls in DME implementation based upon experiences of multiple stakeholders with both successful and unsuccessful outcomes. METHODS: Data were obtained through document analysis (n = 64, spanning 2009-2016; perspectives of government, senior leadership, management and learners), focus groups of management and operations personnel (n = 10) and interviews of senior leaders (n = 4). Challenges and success factors were ascertained through categorisation. Iterative coding guided by three sensitising frameworks was used to determine themes in organisational dynamics. RESULTS: Both challenges and success factors included contextual variables, governance, inter- and intra-organisational relationships (most common success factor), resources (most common challenge), the learning environment and pedagogy. Management and operations were only a challenge. Organisational themes affecting the outcome and the pitfalls included the pace of development across multiple sites, collaborative governance, continuity in senior leadership, operations alignment and reconciliation of competing goals. CONCLUSIONS: Emerging opportunities for DME can be leveraged through collaborative governance, aligned operations and resolution of competing goals, even in constrained contexts, to translate political will into success; however, there are pitfalls that need to be avoided. Our findings based upon multi-stakeholder perspectives add to the body of knowledge on deployment, carefully considering the conditions for success and associated pitfalls.

Structure of health-care dyad leadership: an organization's experience.

Purpose This study aims to explore the structural aspects (roles, responsibilities and reporting) of dyad leadership in one health-care organization (HCO). Design/methodology/approach The perceptions of 32 leaders (17 physician leaders and 15 dyad co-leaders) in formal leadership positions (six first-level with formal authority limited to teams or divisions, 23 middle-level with wider departmental or program responsibility and three senior-level with institution-wide authority) were obtained through focus groups and surveys. In addition, five senior leaders were interviewed. Descriptive statistics was used for quantitative data, and qualitative data were analyzed for themes by coding and categorization. Findings There are a large number of shared responsibilities in the hybrid model, as most activities in HCOs bridge administrative and professional spheres. These span the leadership (e.g. global performance and quality improvement) and management (e.g. human resources, budgets and education delivery) domains. The individual responsibilities, except for staff and physician engagement are in the management domain (e.g. operations and patient care). Both partners are responsible for joint decision-making, projecting a united front and joint reporting through a quadrat format. The mutual relationship and joint accountability are key characteristics and are critical to addressing potential conflicts and contradictions and achieving coherence. Practical implications Clarity of role will assist development of standardized job descriptions and required competencies, recruitment and leadership development. Originality/value This is an original empirical study presenting an integrated view of dyad leaders and senior leadership, meaningful expansion of shared responsibilities including academic functions and developing mutual relationship and emphasizing the central role of stability generating management functions.

Sudden unexpected death in epilepsy in children: a focused review of incidence and risk factors.

Sudden unexpected death in epilepsy (SUDEP) in children, although rare, needs critical attention given the tragic nature and devastating consequences for families and caregivers. True incidence is unknown and risk factors are not completely understood, more so in children compared with adults. A focused narrative review of available studies on paediatric SUDEP was undertaken to comprehend its risk factors and to develop strategies to recognise and where possible modify SUDEP risk and ultimately reduce incidence. We reviewed 16 population-based studies from various settings. We found overlapping risk factors from different studies. The prime risk factor is uncontrolled seizures. This review supports the view that children entering adolescence with optimal seizure control could be a key aspect in reducing adult mortality related to SUDEP. Ideally, clinicians would want to be able to predict prospective, individualised SUDEP risk, which is challenging due to a myriad of risk factors and an inherent non-homogeneous paediatric epilepsy population. Nevertheless, an adequate evidence base exists as evidenced by this review to support information giving and communication to support young people with epilepsy and their families in being active partners in recognising and reducing their SUDEP risk. More work particularly in the form of prospective studies and registries are needed to further clarify true incidence which may have been previously underestimated and to update risk factors.

Smoothing the Transition Points in Canadian Medical Education.

In 2010, the Association of Faculties of Medicine of Canada, Collège des médecins du Québec, College of Family Physicians of Canada, and Royal College of Physicians and Surgeons of Canada launched the Future of Medical Education in Canada Postgraduate (FMEC PG) Project to examine postgraduate medical education (PGME) in Canada and make recommendations for improvement. One recommendation that emerged concerns the transitions learners experience across the undergraduate medical education-PGME-practice continuum. The FMEC PG, using a thorough process, developed projects to address these often-tumultuous transitions for the learner, aiming to provide support, tools, and standards for the learner's educational journey.With leadership by two senior academics and the Transitions Implementation Committee, three working groups helped implement these transitions projects, which addressed (1) the medical-school-to-residency transition, (2) career planning and the residency matching process, and (3) the residency-to-practice transition. Work products include the development of a learner education handover protocol and the establishment of pan-Canadian entrustable professional activities to be used nationally to help define expectations for new graduates entering residencies. A postmatch boot camp tool and a simulated night on-call tool were developed and are available to all medical schools. National standards are being promoted for career services counseling and best practices in residency selection. A practice management curriculum framework, mentorship resources, resiliency training for graduating residents, and the entry-level disciplines of residency are also being explored.Ultimately, with system-wide change and better integration of all players, transitions for Canada's learners will greatly improve.

Goleman's Leadership styles at different hierarchical levels in medical education.

BACKGROUND: With current emphasis on leadership in medicine, this study explores Goleman's leadership styles of medical education leaders at different hierarchical levels and gain insight into factors that contribute to the appropriateness of practices. METHODS: Forty two leaders (28 first-level with limited formal authority, eight middle-level with wider program responsibility and six senior- level with higher organizational authority) rank ordered their preferred Goleman's styles and provided comments. Eight additional senior leaders were interviewed in-depth. Differences in ranked styles within groups were determined by Friedman tests and Wilcoxon tests. Based upon style descriptions, confirmatory template analysis was used to identify Goleman's styles for each interviewed participant. Content analysis was used to identify themes that affected leadership styles. RESULTS: There were differences in the repertoire and preferred styles at different leadership levels. As a group, first-level leaders preferred democratic, middle-level used coaching while the senior leaders did not have one preferred style and used multiple styles. Women and men preferred democratic and coaching styles respectively. The varied use of styles reflected leadership conceptualizations, leader accountabilities, contextual adaptations, the situation and its evolution, leaders' awareness of how they themselves were situated, and personal preferences and discomfort with styles. The not uncommon use of pace-setting and commanding styles by senior leaders, who were interviewed, was linked to working with physicians and delivering quickly on outcomes. CONCLUSIONS: Leaders at different levels in medical education draw from a repertoire of styles. Leadership development should incorporate learning of different leadership styles, especially at first- and mid-level positions.