Development of the McMaster Embalming Scale (MES) to assess embalming solutions for surgical skills training

Human cadavers used for surgical training are embalmed using various methods to facilitate tissue storage and longevity while preserving the natural characteristics required to achieve high fidelity functional task alignment. However, there are no standardized means to evaluate the suitability of embalming solutions for this purpose. The McMaster Embalming Scale (MES) was developed to assess the extent to which embalming solutions allow tissues to achieve physical and functional correspondence to clinical contexts. The MES follows a five-point Likert scale format and evaluates the effect of embalming solutions on tissue utility in seven domains. This study aims to determine the reliability and validity of the MES by presenting it to users after performing surgical skills on tissues embalmed using various solutions. A pilot study of the MES was conducted using porcine material. Surgical residents of all levels and faculty were recruited via the Surgical Foundations program at McMaster University. Porcine tissue was unembalmed (fresh- frozen) or embalmed using one of seven solutions identified in the literature. Participants were blinded to the embalming method as they completed four surgical skills on the tissue. After each performance, participants evaluated their experience using the MES. Internal consistency was evaluated using Cronbach's alpha. Domain to total correlations and a g-study were also conducted. Formalin-fixed tissue achieved the lowest average scores, while fresh frozen tissue achieved the highest. Tissues preserved using Surgical Reality Fluid (Trinity Fluids, LLC, Harsens Island, MI) achieved the highest scores among embalmed tissues. The Cronbach's alpha scores varied between 0.85-0.92, indicating a random sample of new raters would offer similar ratings using the MES. All domains except odor were positively correlated. The g-study indicated that the MES is able to differentiate between embalming solutions, but an individual rater's preference for certain tissue qualities also contributes to the variance in scores captured. This study evaluated the psychometric characteristics of the MES. Future steps to this investigation include validating the MES on human cadavers. This article is protected by copyright. All rights reserved.

Gender and Sex in Medical Practice: An Exploratory Study on Knowledge, Behavior, and Attitude among Sicilian Physicians

Personalized medicine is a new paradigm in health care, and the concept of socio-cultural gender, as opposed to biological sex, emerged in several medical approaches. This exploratory study aimed to investigate the knowledge of sex and gender in clinical medicine among Sicilian physicians. Data collection was based on an online survey sent to the members of the Medical Councils of Sicily (Italy). The questionnaire included nine specific items about awareness and attitudes regarding gender medicine and its importance in clinical practice. 8023 Sicilian physicians received the solicitation e-mail and only 496 responded. Regarding the knowledge of gender medicine, 71.1% of participants stated that they know it, while 88.5% believe that gender medicine should be included in training programs. Similarly, a high percentage (77.6%) would like to keep up to date on this topic. Physicians sampled seem to understand the importance of gender medicine principles, although their experience of some gender issues (i.e., sex disparities in acute cardiovascular care and smoking cessation strategies) is low (55.44% and 21.57%, respectively). The results of this exploratory study should encourage facing the gender medicine gap in the current curricula of health professionals and should implement the transitional value of sex and gender principles in the clinical setting.

Comparison of a U.S. and Zambian Ob/Gyn Residency Training Programme

Introduction

The major objective of the study was to compare and contrast a U.S. and Zambian Ob/Gyn residency programme, using uniform metrics, as the basis for an initial exploration of perceived inequities in post-graduate medical education between low- and high-income countries.

Methods

Measurements of the following procedures were used to indicate whether minimum standards had been met by trainees in their respective postgraduate programmes: vaginal deliveries; C-sections; abdominal, vaginal and laparoscopic hysterectomies; other laparoscopic surgeries; cancer cases; abortions; obstetrical ultrasounds; cystoscopies; incontinence and pelvic floor surgeries. Evaluations were also made with respect to the presence or absence of an official ultrasound rotation, subspeciality and off-service rotations, protected didactic time and exclusive time on obstetrics and gynaecologic clinical services. Comparisons were made relative to these various categories and the average procedural numbers at each level of training to determine differences in trends and degree of exposure.

Results

Minimal procedural requirements were met by both the U.S. and Zambian programmes. For open surgical cases, the minimum standards were higher for the Zambian programme, whereas for procedures associated with the use of high-end technology, such as ultrasound and minimally invasive surgery, minimum standards were higher for the U.S. programme.

Conclusion

There were no significant differences in the Zambian and U.S. Ob/Gyn post-graduate training programmes, relative to their respective metrics. A more extensive analysis is required to determine the actual competency levels that are produced by the respective training systems.

Academic Half-Day Education Experience in Post-graduate Medical Training: A Scoping Review of Characteristics and Learner Outcomes

Background

The academic half-day (AHD) has grown in popularity for medical education because it intends to provide learners with uninterrupted, immersive learning time that may promote participant attendance, engagement, and knowledge. Little is known about the extent of use, forms, or effectiveness of AHD in Post-graduate medical education. This scoping review summarizes existing literature and describes the learning outcomes, according to the Kirkpatrick model of learning evaluation, of AHD experiences on Post-graduate medical trainees.

Methods

Authors used Arksey and O'Malley's methodological framework, searching electronic scientific literature databases from the years of 1977-2019 with relevant key terms and identifying 735 papers. Two independent raters completed title/abstract screening and then extracted pertinent data from papers meeting specified criteria.

Results

Authors identified 38 relevant papers published in English, originating from programs in US (n = 19) and Canada (n = 19), spanning 4 disciplines: Medicine (n = 17, 45%), Pediatrics (n = 10, 26%), Critical Care/Surgery (n = 9, 24%), Radiology (n = 2, 5%). A majority (n = 33, 87%) described specific educational experiences; most focused on residents only (n = 27). The educational experiences included various teaching strategies; few were didactics only (n = 4) and most were multi-modal including simulation, case-based learning, problem-based learning, and/or self-directed online study. AHD size ranged from 5 to 364 participants (median 39). AHD length was 1.5-6 h (median 3). Required resources were inconsistently described. When evaluations of the specific educational experience were reported (n = 35 studies), the majority of studies used weak research designs (e.g., one group, pre/post-test, n = 19); few studies used strong research designs (e.g., randomized controlled trial, n = 2). Positive effects of AHD ranged across Kirkpatrick levels 1-3 learner outcomes.

Conclusions

The composition and content of AHD in Post-graduate medical education vary. Few studies of AHD use stringent research designs, and none include learner outcome measures at the highest Kirkpatrick level (i.e., level 4 results/patient outcomes). A consensus definition and further high-quality research on AHD in Post-graduate medical education is needed.

Integrating leadership development into radiation oncology training: A qualitative analysis of resident interviews

PURPOSE

Radiation oncologists need to have more than sound clinical and technical competencies. To optimize care for patients and advance all aspects of radiation oncology (RO), radiation oncologists must also be effective leaders. Embedding systematic leadership education into RO training programs is challenging. This study examined RO residents' perspectives and preferences relating to leadership education. Such data informs the integration of universal leadership learning into RO training in Australian and New Zealand, and identifies priority areas to facilitate successful leadership development initiatives in RO training programs worldwide.

METHODS AND MATERIALS

Semi-structured telephone interviews were conducted with 13 RO residents across eight Australian training departments and all stages of training. Data from transcriptions of taped interviews were coded by ≥ 2 researchers and collected to saturation. Qualitative thematic analysis was conducted employing an iterative inductive process to develop codes into themes and subthemes. Representative quotes were collated to illustrate subthemes.

RESULTS

Four key themes related to leadership education were identified and labelled: (1) Recognition, credibility and value of education, (2) Logistics of formal learning, (3) Real-world opportunities: 'seeing and doing', and (4) One size does not fit all. Residents unanimously felt formal leadership education was important and that aspects of becoming a good leader could be learned. Organisational and cultural factors emerged as either barriers or facilitators to learning. There was strong support for interactive methods of learning, and role-modelling by senior colleagues was identified as having a major impact on junior learners.

CONCLUSIONS

This study offers insight into RO residents' perspectives and preferences around their own leadership development. Findings have practical implications for the design of effective RO leadership programs and bring us one step closer to the ultimate goal of enhancing leadership capability for all RO professionals.

Assessing exposure to dermoscopy in plastic surgery training programs

BACKGROUND

Dermoscopy is a noninvasive tool that improves the diagnostic accuracy of melanoma and other cutaneous malignancies; yet, it is not widely used by plastic surgeons, who commonly manage skin lesions. Thus, the purpose of this study was to explore current practice patterns and knowledge of dermoscopy among plastic surgeons and postgraduate plastic surgery trainees. Additionally, interest to establish a formal dermoscopy curriculum as part of plastic surgery residency training was evaluated.

METHODS

An online electronic questionnaire was developed and distributed through email to practicing plastic surgeons and plastic surgery trainees at two Canadian universities.

RESULTS

Of the 59 potential participants, 27 (46%) responded. While the majority of participants were familiar with dermoscopy (n = 26; 96%), only one respondent reported using dermoscopy in clinical practice. However, all respondents reported exposure to melanoma clinically (n = 26; one participant did not provide a response). A lack of training, along with lack of access to dermatoscopes, were the most frequently cited reasons for not using dermoscopy. Knowledge scores with regard to dermoscopic features were also low; coupled with a noted propensity toward diagnostic or excisional biopsy, whichcould raise the benign to malignant ratio. Overall, 89% (n = 24) of respondents expressed interest in dermoscopy training in plastic surgery postgraduate training.

CONCLUSIONS

Few responding plastic surgeons or plastic surgery residents currently use dermoscopy in training or practice but are interested in formal dermoscopy training in residency.

Building regional anesthesia capacity in limited-resource settings: a pilot study evaluating a 4-week curriculum

Aim: To pilot a 4-week regional anesthesia curriculum for limited-resource settings. Intervention: A baseline needs assessment and knowledge test were deployed. The curriculum included lectures and hands-on teaching, followed by knowledge attainment tests. Results: Scores on the knowledge test improved from a mean of 37.1% (SD 14.7%) to 50.9% (SD 18.6%) (p = 0.017) at 4 weeks and 49% at 24 months. An average of 1.7 extremity blocks per month was performed in 3 months prior to the curriculum, compared with an average of 4.1 per month in 8 months following. Conclusion: This collaborative curriculum appeared to have a positive impact on the knowledge and utilization of regional anesthesia.

Educational Impact Drives Feasibility of Implementing Daily Assessment in the Workplace

Construct: Authors investigated the perspectives of stakeholders on feasibility elements of workplace-based assessments (WBA) with varying designs. Background: In the transition to competency-based medical education, WBA are taking a more prominent role in assessment programs. However, the increased demand for WBA leads to new challenges for implementing suitable WBA tools with published validity evidence, while also being feasible and useful in practice. Despite the availability of published WBA tools, implementation does not necessarily occur; a more fulsome understanding of the perspectives of stakeholders who are ultimately the end-users of these tools, as well as the system factors that both deter or support their use, could help to explain why evidence-based assessment tools may not be incorporated into residency programs. Approach: We examined the perspectives of two groups of stakeholders, surgical teachers and resident learners, during an assessment intervention that varied the assessment tools while keeping the assessment process constant. We chose diverse exemplars from published assessment tools that each represented a different response format: global rating scales, step-by-step surgical rubrics, and an entrustability scale. The primary purpose was to investigate how stakeholders are impacted by WBA tools with varying response formats to better understand their feasibility for assessment of cataract surgery. Secondarily, we were able to explore the culture of assessment in cataract surgery education including stakeholders' perceptions of WBA unrelated to assessment form design. Semi-structured interviews with teachers and a focus group with the residents enabled discussion of their perspectives on dimensions of the tools such as acceptability, demand, implementation, practicality, adaptation, and integration. Findings: Three themes summarize teachers' and residents' experiences with the assessment tools: (1) Feedback is the priority; (2) Forms informing coaching; and (3) Forcing the conversation. The tools helped to facilitate the feedback conversation by serving as a reminder to initiate the conversation, a framework to structure the conversation, and a memory aid for providing detailed feedback. Surgical teachers preferred the assessment tool with a design that best aligned with their approach to teaching and how they wanted to provide feedback. Orientation to the tools, combined with established remediation pathways, may help preceptors to better use assessment tools and improve their ability to give critical feedback. Conclusions: Feedback, more so than assessment, dominated the comments provided by both teachers and residents after using the various WBA tools. Our typical assessment design efforts focus on the creation or selection of a robust assessment tool according to good design and measurement principles, but the current findings would encourage us to also prioritize the coaching relationship and include efforts to design WBA tools to function as a mediator to augment teaching, learning, and feedback exchange within that relationship in the workplace.

Education Indicators for Internal Medicine Point-of-Care Ultrasound: a Consensus Report from the Canadian Internal Medicine Ultrasound (CIMUS) Group

BACKGROUND

Curriculum development and implementation for internal medicine point-of-care ultrasound (IM POCUS) continues to be a challenge for many residency training programs. Education indicators may provide a useful framework to support curriculum development and implementation efforts across programs in order to achieve a consistent high-quality educational experience.

OBJECTIVE

This study seeks to establish consensus-based recommendations for education indicators for IM POCUS training programs in Canada.

DESIGN

This consensus study uses a modified nominal group technique for voting in the initial round, followed by two additional rounds of online voting, with consensus defined as agreement by at least 80% of the participants.

PARTICIPANTS

Participants were 22 leaders with POCUS and/or education expertise from 13 Canadian internal medicine residency programs across 7 provinces.

MAIN MEASURES

Education indicators considered were those that related to aspects of the POCUS educational system, could be presented by a single statistical measure, were readily understood, could be reliably measured to provide a benchmark for measuring change, and represented a policy issue. We excluded a priori indicators with low feasibility, are impractical, or assess learner reactions. Candidate indicators were drafted by two academic internists with post-graduate training in POCUS and medical education. These indicators were reviewed by two internists with training in quality improvement prior to presentation to the expert participants.

KEY RESULTS

Of the 52 candidate education indicators considered, 6 reached consensus in the first round, 12 in the second, and 4 in the third round. Only 5 indicators reached consensus to be excluded; the remaining indicators did not reach consensus.

CONCLUSIONS

The Canadian Internal Medicine Ultrasound (CIMUS) group recommends 22 education indicators be used to guide and monitor internal medicine POCUS curriculum development efforts in Canada.

Curated Collections for Educators: Five Key Papers about Receiving Feedback in Medical Education

Introduction Feedback is a complex, multi-component interaction that is essential for academic development and advancement. Successful feedback requires active involvement from both the giver and receiver. However, research and guidance on the subject mostly center on the role of the provider of feedback. But the receiver of feedback holds the true power in this interaction, choosing how to interpret the information and deciding whether or not to incorporate the feedback to instill behavioral change. In this article, the authors aim to summarize five key papers related to receiving feedback, in order to outline both relevant information for emerging clinician-educators and discern ways to use this information for faculty development. Methods In order to generate a list of key papers that describe the importance of receiving feedback, the authors conducted a consensus-building process informed by social media sources. Key articles on receiving feedback were aggregated through a literature search. This list was further augmented via an open call on Twitter for important papers regarding receiving feedback. Through these processes, a list of 43 papers was created on the topic of receiving feedback in medical education. After compiling this preliminary list, the authorship group engaged in a modified Delphi approach to build consensus on selecting papers that best described the process of receiving feedback. Results We present the group's five most highly rated papers on the topic of receiving feedback in medical education. These papers were deemed essential and have also been summarized based on their relevance to junior faculty members and faculty developers. Conclusion While giving and receiving feedback are both vital for growth and development, much of the research focuses solely on giving feedback. However, receiving feedback is equally, if not more, important for instilling change in the learner. We explore the power of receiving feedback in medical education through five key papers that analyze the subject. We believe these papers can serve as great learning resources for both junior faculty members and faculty developers. They can assist the junior faculty to cultivate the ability to receive feedback and also serve as resources to aid senior faculty in building faculty-development sessions.

Near peer teaching in general practice: option or expectation?

General Practice (GP) trainees who teach medical students do so as near peers with established educational benefits for all concerned. Through teaching, GP trainees consolidate their own knowledge and skills whilst students value the experience of learning from teachers closer in age and stage. Importantly, involving GP trainees as teachers increases primary care teaching capacity and promotes GP as a potential career option for undergraduates. However, whilst junior doctors are often to be found teaching on hospital wards and in clinics, GP trainees based in primary care appear to have fewer opportunities to teach. This article encourages the promotion of near peer teaching in primary care on several levels. We make practical suggestions of potential benefit to the individual GP trainee, trainer and practice. We also discuss ways in which key stakeholders, including medical schools and those organising post-graduate primary care training programmes, may promote near peer teaching in GP. We propose that all medical students should have experience of being taught by GP trainees, and that all future general practitioners should have training and experience of teaching undergraduate medical students.

Supervision contracts for mental health professionals: a systematic review and exploration of the potential relevance to psychiatry training in Australia and New Zealand

OBJECTIVE

The use of formal supervision contracts has been strongly advocated across non-medical mental health professions. However, the use of such agreements is not a feature of the RANZCP Competency-Based Fellowship Program. This paper critically examines the evidence to support the use of formal supervision contracts.

METHOD

A systematic review of empirical studies relating to the outcomes of supervision contracts was completed. Included records were subject to quality appraisal.

RESULTS

Two studies met the inclusion criteria; both were assessed to be of poor quality. One study found improved supervision effectiveness associated with the use of supervision contracts, and the other found no significant differences associated with formal contracting.

CONCLUSION

Despite strong advocacy, limited empirical evidence was found to support the value of formal supervision contracts across mental health professions. PROSPERO registration - PROSPERO 2018 CRD42018104142.

Development of a competency-based medical education curriculum for antimicrobial stewardship

BACKGROUND

Antimicrobial stewardship (AS) programs are becoming a critical part of infectious diseases (ID) and medical microbiology training programs. As post-graduate medical education shifts toward competency-based medical education (CBME), the curriculum for AS training requires a similar transition. Our objective was to develop an educational curriculum combining principles of AS and CBME and apply a prospective audit and feedback (PAF) as an educational strategy.

METHODS

A new competency-based educational curriculum (CBEC) was created which addressed multiple stages along the competence continuum. The Centers for Disease Control and Prevention (CDC) core elements for AS were used to generate Entrustable Professional Activities (EPAs) and milestones for this CBEC.

RESULTS

Trainees completed a PAF as an AS educational strategy on all antimicrobial starts in a pediatric hospital (141 beds) over a 1-month rotation. The PAF created 26 audits and addressed all (100%) of the CDC's core elements for inpatient AS programs through seven EPAs and 20 milestones.

CONCLUSIONS

The PAF allowed for 26 interventions to improve effective antimicrobial use and mapped to multiple EPAs and milestones. Additionally, the PAF utilized all of the CDC's core elements for inpatient AS programs. It is imperative to ensure that educational strategies expose residents to AS interventions that have been shown to decrease antimicrobial usage in various settings. The current manuscript may serve as a model for how a CBEC can be developed, and how AS interventions can be integrated into a CBME program.

Can radiation oncologists learn to be better leaders? Outcomes of a pilot Foundations of Leadership in Radiation Oncology program for trainees delivered via personal electronic devices

INTRODUCTION

There has been no systematic attempt to enhance leadership capacity within radiation oncology as an integrated component of training. This pilot study examines an intervention to introduce basics of leadership learning to radiation oncology trainees.

METHODS

A case-based learning tool was designed for delivery via trainees' personal electronic devices. Eight typical workplace case scenarios representing leadership challenges were followed by multiple choice questions, key learning points and hyperlinks to relevant resources. Cases were automatically sent every few days over 4 weeks and participants' responses anonymously collated by the delivery platform (QStream). In addition, an online survey was sent at completion of the program to capture trainees' perspectives on the utility of this tool.

RESULTS

Thirty-seven of 45 (82%) trainees participated: 21 females and 16 males. Twenty-six of 37 (70%) starting the program completed it. Sixteen (62% of 'completers') responded to the post-program survey. Fourteen of 16 (87.5%) agreed to the program and helped them identify ways they were already exhibiting leadership. Eleven of 16 (68.8%) agreed they had acquired knowledge that could assist them in being better leaders. Fifteen of 16 said the program made them consider future leadership possibilities in radiation oncology. Fourteen of 15 enjoyed the digital format. Most suggestions for improvement linked to a desire for more interactivity in learning these skills.

CONCLUSION

Piloting an online tool designed to introduce foundation leadership concepts to radiation oncology trainees has provided useful feedback to guide further development in this area. Although this method had high feasibility, it revealed the need for additional interactive methods for leadership learning.

The Academic Backbone: longitudinal continuities in educational achievement from secondary school and medical school to MRCP(UK) and the specialist register in UK medical students and doctors

BACKGROUND

Selection of medical students in the UK is still largely based on prior academic achievement, although doubts have been expressed as to whether performance in earlier life is predictive of outcomes later in medical school or post-graduate education. This study analyses data from five longitudinal studies of UK medical students and doctors from the early 1970s until the early 2000s. Two of the studies used the AH5, a group test of general intelligence (that is, intellectual aptitude). Sex and ethnic differences were also analyzed in light of the changing demographics of medical students over the past decades.

METHODS

Data from five cohort studies were available: the Westminster Study (began clinical studies from 1975 to 1982), the 1980, 1985, and 1990 cohort studies (entered medical school in 1981, 1986, and 1991), and the University College London Medical School (UCLMS) Cohort Study (entered clinical studies in 2005 and 2006). Different studies had different outcome measures, but most had performance on basic medical sciences and clinical examinations at medical school, performance in Membership of the Royal Colleges of Physicians (MRCP(UK)) examinations, and being on the General Medical Council Specialist Register.

RESULTS

Correlation matrices and path analyses are presented. There were robust correlations across different years at medical school, and medical school performance also predicted MRCP(UK) performance and being on the GMC Specialist Register. A-levels correlated somewhat less with undergraduate and post-graduate performance, but there was restriction of range in entrants. General Certificate of Secondary Education (GCSE)/O-level results also predicted undergraduate and post-graduate outcomes, but less so than did A-level results, but there may be incremental validity for clinical and post-graduate performance. The AH5 had some significant correlations with outcome, but they were inconsistent. Sex and ethnicity also had predictive effects on measures of educational attainment, undergraduate, and post-graduate performance. Women performed better in assessments but were less likely to be on the Specialist Register. Non-white participants generally underperformed in undergraduate and post-graduate assessments, but were equally likely to be on the Specialist Register. There was a suggestion of smaller ethnicity effects in earlier studies.

CONCLUSIONS

The existence of the Academic Backbone concept is strongly supported, with attainment at secondary school predicting performance in undergraduate and post-graduate medical assessments, and the effects spanning many years. The Academic Backbone is conceptualized in terms of the development of more sophisticated underlying structures of knowledge ('cognitive capital' and 'medical capital'). The Academic Backbone provides strong support for using measures of educational attainment, particularly A-levels, in student selection.

TRIG on TRACK: educating pathology residents in genomic medicine

Genomic technologies are dramatically changing the practice of medicine. Next-generation sequencing has allowed prognostic stratification of cancer patients, personalized drug therapy and the identification of genetic risk factors for a multitude of diseases. As the physicians who oversee tissue- and laboratory-based diagnostic testing, pathologists must understand and utilize this new technology for the benefit of patients; however, only a minority of pathology residency programs currently provide training in genomics. In response to this urgent need, the Training Residents in Genomics (TRIG) Working Group has made significant progress towards creating, implementing, evaluating and disseminating a national curriculum in genomic pathology. Although presented in the context of pathology training, the approach described in this review can serve as model for education in genomic medicine of students, trainees or professionals in other areas of healthcare.