Correction to: Cluster identification, selection, and description in Cluster randomized crossover trials: the PREP-IT trials

An amendment to this paper has been published and can be accessed via the original article

Orthopaedic Travelling Fellowship Programs: A Survey of Canadian Applicants and Participants

Background: Despite the well-documented benefits of travelling fellowships, there is a lack of female applicants to travelling fellowship programs. There is also a limited amount of research that has been conducted regarding travelling fellowships. Therefore, the aims of this study were fourfold: (1) to determine the number and gender of successful applicants for fellowship programs, (2) to determine any perceived barriers for both men and women to participating in travelling fellowship programs, (3) to explore possible support systems to address these barriers, and (4) to explore any differences among genders regarding perceived barriers to participating in travelling fellowship programs. Methods: A 41-item cross-sectional survey was distributed to all Canadian Orthopaedic Association (COA) members who applied for a COA travelling fellowship program between 2004 and 2019. There were 78 applicants of which 26 were women (33%). Up to 3 reminder emails were sent every two weeks after the initial invitations to encourage participation. Descriptive statistics were performed. Results: A total of 103 fellowship applications were submitted, 26% from female applicants. Thirty-one (39%) of the applications submitted by men were successful and 10 (33%) of the applications submitted by women were successful. Nineteen individuals completed the survey with a gender distribution equal to the non-responders. The most common perceived barriers were time constraints (65%) and family obligations (47%), with 24% of respondents identifying no perceived barriers at all. No respondent identified concerns for sexual or gender-based harassment. Eightyfive percent of individuals responded that the perceived barriers were not related to their gender. Most respondents (87%) suggested a mentorship program to increase the number of female applicants to COA travelling fellowship programs. Conclusions: Women are less likely to apply for orthopaedic travelling fellowships in Canada; however, the success rate of applications submitted by women is similar to that of applications submitted by men. When applying to COA travelling fellowship programs, the majority of applicants identified barriers including time constraints and family obligations. In general, these barriers were not perceived to be related to their gender. The findings of this study may encourage more women to apply to COA travelling fellowship programs

Guidelines for short-term medical missions: perspectives from host countries

Abstract Background In the past decade, there has been increasing guideline development for short-term medical missions (STMMs) traveling from high-income to low- and middle-income countries for the purpose of supporting health care services. The ethics of STMMs is criticized in the literature and there is frequently a lack of host country collaboration. This typically results in guidelines which are developed through the lens of the sending (high-income) countries’ staff and organizations. The aim of this paper is to evaluate an existing best practice guideline document from the perspective of host country participants with knowledge of STMMs from Honduras, Malawi, and the Philippines. Methods The guideline used for the evaluation consisted of nine best practice elements that were discerned based on literature and the experience of those working within the field. Semi-structured interviews were conducted in a cross-sectional study with participants (n = 118) from the host countries. Thematic analysis was conducted by two researchers and the results were assessed by working group members to confirm interpretations of the data. Results Overall, participants expressed a strong interest in having more structured guidance surrounding STMM practices. There was a positive response to and general acceptance of the proposed STMM guidelines, although participants found the 24-page document onerous to use; a companion checklist was developed. The key themes that emerged from the interviews included collaboration and coordination, care for hard-to-reach communities, capacity building, critical products and essential medical supplies, and opportunity and feasibility. Conclusions Host input suggests that the guidelines provide structured regulation and coordination of the medical mission process and have the potential to improve the way STMMs are carried out. The guidelines have also proven to be a useful tool for the actual implementation of STMMs and can be a tool to strengthen links and trust between mission teams and local health staff. However, local contexts vary considerably, and guidelines must be adapted for local use. It is recommended that STMM teams work in conjunction with host partners to ensure they meet local needs, increase capacity development of local health workers, and provide continuity of care for patients into the local system

Implementing stakeholder engagement to explore alternative models of consent: An example from the PREP-IT trials

Introduction: Cluster randomized crossover trials are often faced with a dilemma when selecting an optimal model of consent, as the traditional model of obtaining informed consent from participant's before initiating any trial related activities may not be suitable. We describe our experience of engaging patient advisors to identify an optimal model of consent for the PREP-IT trials. This paper also examines surrogate measures of success for the selected model of consent. Methods: The PREP-IT program consists of two multi-center cluster randomized crossover trials that engaged patient advisors to determine an optimal model of consent. Patient advisors and stakeholders met regularly and reached consensus on decisions related to the trial design including the model for consent. Patient advisors provided valuable insight on how key decisions on trial design and conduct would be received by participants and the impact these decisions will have. Results: Patient advisors, together with stakeholders, reviewed the pros and cons and the requirements for the traditional model of consent, deferred consent, and waiver of consent. Collectively, they agreed upon a deferred consent model, in which patients may be approached for consent after their fracture surgery and prior to data collection. The consent rate in PREP-IT is 80.7%, and 0.67% of participants have withdrawn consent for participation. Discussion: Involvement of patient advisors in the development of an optimal model of consent has been successful. Engagement of patient advisors is recommended for other large trials where the traditional model of consent may not be optimal