47 research outputs found
CBME framework to promote transition to senior
Residency programs across Canada are transitioning to Competence by Design (CBD). Our innovative framework improves the traditional transition to independent senior overnight call process by adding workplace-based (WBA) assessments. Our process ensures that faculty and residents have a shared understanding of what competencies need to be demonstrated before residents can work independently as the in-house senior resident overnight. This protocol is worth exploring; initial perceptions suggest an increase in resident confidence while on call and improved faculty comfort when paired with these senior residents. We believe that this in turn will be reflected in enhanced patient care
Ăvaluateurs attitrĂ©s : description d'une intervention Ă©ducative inĂ©dite visant Ă faciliter l'observation directe en milieu clinique
Background: The Department of Pediatrics at Queenâs University undertook a pilot project in July 2017 to increase the frequency of direct observations (DO) its residents received without affecting the patient flow in a busy hospital-based pediatric ambulatory care clinic. Facilitating DO for authentic workplace-based assessments is essential for assessing residentâs core competencies. The purpose of this study was to pilot an innovative education intervention to address the challenge of implementing DO in the clinical setting.
Methods: The project allowed for staff physicians to act as âdedicated assessorsâ (DA), a faculty member who was scheduled to conduct direct observations of traineesâ clinical skills, while not acting as the attending physician on duty. At the end of the project, focus group interviews were conducted with faculty and residents, and thematic analysis was completed.
Results: Participants reported an increase in the overall quality of feedback received during the observations performed by a DA, with more specific feedback and a broader focus of assessment. There seemed to be little disruption to patient care. Some residents described the observations as anxiety-provoking.
Conclusions: Overall, this project provides insight into an educational approach that medical residency programs can apply to increase the frequency of workplace-based DO and boost the quality of feedback residents receive while maintaining the flow of already busy ambulatory care clinics.Contexte: En juillet 2017, le dĂ©partement de pĂ©diatrie de lâUniversitĂ© Queenâs a lancĂ© un projet pilote visant Ă augmenter la frĂ©quence des observations directes (OD) dont faisaient lâobjet ses rĂ©sidents sans affecter le flux de patients dans une clinique achalandĂ©e de soins pĂ©diatriques ambulatoires. Il est essentiel de faciliter lâOD, permettant une Ă©valuation authentique en milieu de travail, afin dâĂ©valuer les compĂ©tences fondamentales des rĂ©sidents. Lâobjectif de cette Ă©tude Ă©tait de piloter une intervention Ă©ducative novatrice pour relever le dĂ©fi de la mise en place de lâOD dans le cadre clinique.
MĂ©thodes: Le projet permettait aux mĂ©decins dâagir en tant quâ« Ă©valuateurs attitrĂ©s » (ĂA) : câest-Ă -dire un membre du corps professoral chargĂ© de lâobservation directe des compĂ©tences cliniques des apprenants alors quâil nâĂ©tait pas le mĂ©decin traitant de service. Une analyse thĂ©matique a Ă©tĂ© rĂ©alisĂ©e sur la base dâentrevues de groupe menĂ©es avec le corps professoral et les rĂ©sidents Ă la fin du projet.
RĂ©sultats: Les participants ont signalĂ© une augmentation de la qualitĂ© gĂ©nĂ©rale de la rĂ©troaction reçue au cours des observations effectuĂ©es par un ĂA, notamment des commentaires plus prĂ©cis et une Ă©valuation plus complĂšte. Il semble y avoir eu peu de perturbations dans les soins aux patients. Certains rĂ©sidents ont dĂ©crit les observations comme Ă©tant anxiogĂšnes.
Conclusions: Dans lâensemble, ce projet donne un aperçu dâune approche Ă©ducative qui peut ĂȘtre appliquĂ©e dans le cadre des programmes de rĂ©sidence en mĂ©decine dans le but dâaugmenter la frĂ©quence des OD en milieu de travail et dâamĂ©liorer la qualitĂ© de la rĂ©troaction reçue par les rĂ©sidents sans perturber le flux de patients dans les cliniques de soins ambulatoires dĂ©jĂ trĂšs achalandĂ©es
Sept façons Ă prendre en main la mise en Ćuvre de la formation mĂ©dicale fondĂ©e sur les compĂ©tences au niveau des programmes
Competency-based medical education (CBME) curricula are becoming increasingly common in graduate medical education. Put simply, CBME is focused on educational outcomes, is independent of methods and time, and is composed of achievable competencies.1 In spite of widespread uptake, there remains much to learn about implementing CBME at the program level. Leveraging the collective experience of program leaders at Queenâs University, where CBME simultaneously launched across 29 specialty programs in 2017, this paper leverages change management theory to provide a short summary of how program leaders can navigate the successful preparation, launch, and initial implementation of CBME within their residency programs
Noninvasive optical inhibition with a red-shifted microbial rhodopsin
Optogenetic inhibition of the electrical activity of neurons enables the causal assessment of their contributions to brain functions. Red light penetrates deeper into tissue than other visible wavelengths. We present a red-shifted cruxhalorhodopsin, Jaws, derived from Haloarcula (Halobacterium) salinarum (strain Shark) and engineered to result in red lightâinduced photocurrents three times those of earlier silencers. Jaws exhibits robust inhibition of sensory-evoked neural activity in the cortex and results in strong light responses when used in retinas of retinitis pigmentosa model mice. We also demonstrate that Jaws can noninvasively mediate transcranial optical inhibition of neurons deep in the brains of awake mice. The noninvasive optogenetic inhibition opened up by Jaws enables a variety of important neuroscience experiments and offers a powerful general-use chloride pump for basic and applied neuroscience.McGovern Institute for Brain Research at MIT (Razin Fellowship)United States. Defense Advanced Research Projects Agency. Living Foundries Program (HR0011-12-C-0068)Harvard-MIT Joint Research Grants Program in Basic NeuroscienceHuman Frontier Science Program (Strasbourg, France)Institution of Engineering and Technology (A. F. Harvey Prize)McGovern Institute for Brain Research at MIT. Neurotechnology (MINT) ProgramNew York Stem Cell Foundation (Robertson Investigator Award)National Institutes of Health (U.S.) (New Innovator Award 1DP2OD002002)National Institute of General Medical Sciences (U.S.) (EUREKA Award 1R01NS075421)National Institutes of Health (U.S.) (Grant 1R01DA029639)National Institutes of Health (U.S.) (Grant 1RC1MH088182)National Institutes of Health (U.S.) (Grant 1R01NS067199)National Science Foundation (U.S.) (Career Award CBET 1053233)National Science Foundation (U.S.) (Grant EFRI0835878)National Science Foundation (U.S.) (Grant DMS0848804)Society for Neuroscience (Research Award for Innovation in Neuroscience)Wallace H. Coulter FoundationNational Institutes of Health (U.S.) (RO1 MH091220-01)Whitehall FoundationEsther A. & Joseph Klingenstein Fund, Inc.JPB FoundationPIIF FundingNational Institute of Mental Health (U.S.) (R01-MH102441-01)National Institutes of Health (U.S.) (DP2-OD-017366-01)Massachusetts Institute of Technology. Simons Center for the Social Brai
Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries
Abstract
Background
Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres.
Methods
This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and lowâmiddle-income countries.
Results
In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of âsingle-useâ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for lowâmiddle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia.
Conclusion
This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both highâ and lowâmiddleâincome countries
Competence committee: How meeting frequency impacts committee function and learner-centered assessment
Dedicated Assessors: description of an innovative education intervention to facilitate direct observation in the clinical setting
Background: The Department of Pediatrics at Queenâs University undertook a pilot project in July 2017 to increase the frequency of direct observations (DO) its residents received without affecting the patient flow in a busy hospital-based pediatric ambulatory care clinic. Facilitating DO for authentic workplace-based assessments is essential for assessing residentâs core competencies. The purpose of this study was to pilot an innovative education intervention to address the challenge of implementing DO in the clinical setting.Methods: The project allowed for staff physicians to act as âdedicated assessorsâ (DA), a faculty member who was scheduled to conduct direct observations of traineesâ clinical skills, while not acting as the attending physician on duty. At the end of the project, focus group interviews were conducted with faculty and residents, and thematic analysis was completed.Results: Participants reported an increase in the overall quality of feedback received during the observations performed by a DA, with more specific feedback and a broader focus of assessment. There seemed to be little disruption to patient care. Some residents described the observations as anxiety-provoking.Conclusions: Overall, this project provides insight into an educational approach that medical residency programs can apply to increase the frequency of workplace-based DO and boost the quality of feedback residents receive while maintaining the flow of already busy ambulatory care clinics.Contexte: En juillet 2017, le dĂ©partement de pĂ©diatrie de lâUniversitĂ© Queenâs a lancĂ© un projet pilote visant Ă augmenter la frĂ©quence des observations directes (OD) dont faisaient lâobjet ses rĂ©sidents sans affecter le flux de patients dans une clinique achalandĂ©e de soins pĂ©diatriques ambulatoires. Il est essentiel de faciliter lâOD, permettant une Ă©valuation authentique en milieu de travail, afin dâĂ©valuer les compĂ©tences fondamentales des rĂ©sidents. Lâobjectif de cette Ă©tude Ă©tait de piloter une intervention Ă©ducative novatrice pour relever le dĂ©fi de la mise en place de lâOD dans le cadre clinique.MĂ©thodes: Le projet permettait aux mĂ©decins dâagir en tant quâ« évaluateurs attitrĂ©s » (ĂA) : câest-Ă -dire un membre du corps professoral chargĂ© de lâobservation directe des compĂ©tences cliniques des apprenants alors quâil nâĂ©tait pas le mĂ©decin traitant de service. Une analyse thĂ©matique a Ă©tĂ© rĂ©alisĂ©e sur la base dâentrevues de groupe menĂ©es avec le corps professoral et les rĂ©sidents Ă la fin du projet.RĂ©sultats: Les participants ont signalĂ© une augmentation de la qualitĂ© gĂ©nĂ©rale de la rĂ©troaction reçue au cours des observations effectuĂ©es par un ĂA, notamment des commentaires plus prĂ©cis et une Ă©valuation plus complĂšte. Il semble y avoir eu peu de perturbations dans les soins aux patients. Certains rĂ©sidents ont dĂ©crit les observations comme Ă©tant anxiogĂšnes.Conclusions: Dans lâensemble, ce projet donne un aperçu dâune approche Ă©ducative qui peut ĂȘtre appliquĂ©e dans le cadre des programmes de rĂ©sidence en mĂ©decine dans le but dâaugmenter la frĂ©quence des OD en milieu de travail et dâamĂ©liorer la qualitĂ© de la rĂ©troaction reçue par les rĂ©sidents sans perturber le flux de patients dans les cliniques de soins ambulatoires dĂ©jĂ trĂšs achalandĂ©es