Case Report: Defining Applicant Attributes to Be Prioritized in the Selection of Child and Adolescent Psychiatry Subspecialty Residents at the University of Toronto.

Background/Objectives: The child and adolescent psychiatry (CAP) subspecialty training program at the University of Toronto was among the first fully accredited CAP programs in Canada. As one of Canada's largest CAP subspecialty programs, we attract many excellent applicants annually. While objectivity and transparency in the selection of candidates have been valued, it was unclear which applicant attributes should be prioritized. This quality improvement project was undertaken to identify the key applicant attributes that should be prioritized for admission to the program. Materials/Methods: An initial list of attributes was compiled by project team members and feedback solicited. Through iterative design, this list was categorized into "end products," "branding attributes" and "generic attributes." The "end products" were removed as these represented outputs of training rather than attributes on which applicant selection should be based. Subsequent steps involved only the "branding" and "generic" attributes. A consensus-building exercise led to the creation of two short-lists of five attributes within each category. Finally, a paired-comparison forced choice methodology was used to determine the ranking of these attributes in order of importance when assessing applicants. Results: The final lists of "generic" and "branding" attributes developed through a consensus-building exercise are presented in rank order based on the paired-comparison methodology. The overall response rate for the forced choice electronic survey was 49% of faculty and learners. Conclusions/Discussion: This project used an iterative process of consensus building & pairwise comparison to prioritize key attributes for assessing trainee selection to the program. Going forward, these attributes will be incorporated into the file review and interview portions of our admissions process. In addition to emphasizing these priority attributes in admissions, there are implications for other aspects of the program including curriculum and faculty development, as well as guiding the overall mission and vision for the Division. A similar process could be undertaken by other training programs seeking to identify priority attributes for admission to their programs.

What's race got to do with it? A proposed framework to address racism's impacts on child and adolescent mental health in Canada.

This commentary responds to current events that have highlighted the ways that systemic racism affects a wide variety of health outcomes. We specifically discuss how systemic racism adversely affects the mental health of children and adolescents in a Canadian context and use a structural framework to demonstrate how race is embedded in various Canadian systems and thus affects child and adolescent mental health in both conscious and unconscious ways throughout the lifespan. Experiences of systemic racism affect the mental health of Canadian young people in multiple complex and intersecting ways including access to care, experience of mental health services, and outcomes of care. We currently lack a national best practice framework for mental health professionals that unifies approaches to research, education, and clinical care for young racialized Canadians; in addition, concerted efforts to collect race-based data are lacking. We suggest that a blueprint for improved services for racialized young people in Canada would include: Development of a funded and sustainable research agenda responsive to community expertise, development and implementation of a Canadian Child and Adolescent task force focused on educational strategies on racism and service provision at both the postgraduate and continuing professional development (CPD) levels, and consideration of clinical parameters that improve access to, and experience of, care for Canadian racialized youth.

Ce commentaire est en réponse aux événements actuels qui ont fait ressortir les façons dont le racisme systémique touche une grande variété de résultats de santé. Nous discutons particulièrement de la façon dont le racisme systémique affecte la santé mentale des enfants et des adolescents dans un contexte canadien et nous utilisons un cadre structurel pour démontrer comment la race est intégrée dans divers systèmes canadiens et qu'elle affecte ainsi la santé mentale des enfants et des adolescents tant au niveau conscient qu'inconscient toute la vie. Les expériences de racisme systémique affectent la santé mentale des jeunes canadiens de multiples façons complexes et croisées, notamment l'accès aux soins, l'expérience des services de santé mentale, et les résultats des soins. Nous n'avons pas présentement de cadre national des pratiques exemplaires pour les professionnels de la santé mentale qui unifie les approches de la recherche de l'éducation, et des soins cliniques pour les jeunes canadiens racialisés; en outre, les efforts concertés pour recueillir les données basées sur la race sont manquants. Nous suggérons qu'un plan de services améliorés pour les jeunes racialisés au Canada comprenne : le développement d'un programme de recherche financé et viable sensible à l'expertise communautaire, la formation et la mise en œuvre d'un groupe de travail pour enfants et adolescents canadiens axé sur les stratégies éducatives à l'égard du racisme, la prestation de services aux niveaux des études supérieures et du développement professionnel continu (DPC), et la prise en compte des paramètres cliniques qui améliorent l'accès aux soins et l'expérience qu'en font les jeunes canadiens racialisés.

Multiple independent sampling within medical school admission interviewing: an "intermediate approach".

INTRODUCTION: Balancing reliability and resource limitations as well as recruitment activities during admission interviews is a challenge for many medical schools. The Modified Personal Interview (MPI) has been shown to have good psychometric properties while being resource efficient for specialized admission interviews. We describe implementation of an MPI adaptation integrating psychometric rigour alongside resourcing and recruitment goals for larger-scale medical school admission interviewing at the University of Toronto. METHODS: The MPI was implemented during the 2013-2014 admission cycle. The MPI uses multiple independent sampling by having applicants interviewed in a circuit of four brief semi-structured interviews. Recruitment is reflected in a longer MPI interviewing time to foster a 'human touch'. Psychometric evaluation includes generalizability studies to examine inter-interview reliability and other major sources of error variance. We evaluated MPI impact upon applicant recruitment yield and resourcing. RESULTS: MPI reliability is 0.56. MPI implementation maintained recruitment compared with previous year. MPI implementation required 160 interviewers for 600 applicants whereas for pre-MPI implementation 290 interviewers were required to interview 587 applicants. MPI score correlated with first year OSCE performance at 0.30 (p < 0.05). DISCUSSION: MPI reliability is measured at 0.56 alongside enhanced resource utilization and maintenance of recruitment yield. This 'intermediate approach' may enable broader institutional uptake of integrated multiple independent sampling-based admission interviewing within institution-specific resourcing and recruitment goals.