Association entre le sexe et l'identité raciale ou ethnique et la réussite au processus d'admission dans une faculté de médecine canadienne : étude de cohorte prospective

Background: Canadian data suggests that Black candidates may be less successful than other groups when applying to medical school. We sought to comprehensively describe the racial and/or ethnic identity, gender identity, sexual orientation, and ability of applicants to a single Canadian medical school. We also examined for an association between success at each application stage and applicant gender and racial identity. Methods: Class of 2024 applicants to a single Canadian medical school were invited to complete a demographics survey. The odds of achieving each application stage (offered an interview, offered a position, and matriculating) were determined for each demographic group. Results: There were 595 participants (32.4% response rate). The demographics of the applicant pool and matriculating class were similar. There was no difference in interview offers or matriculation between BIPOC and white candidates. Cisgender men were overrepresented in interviews compared to cisgender women (OR 0.64; 95%CI 0.43-0.95; p = 0.03) but not in matriculation. BIPOC cisgender women received more interview invitations compared to other groups (OR 2.74, 95%CI 1.20-6.25; p = 0.02). Conclusions: Differences in applicant success for differing demographic groups were most pronounced being offered an interview.Contexte : Des données canadiennes portent à croire que les candidats noirs peuvent avoir moins de succès que d'autres groupes lorsqu'ils postulent à une faculté de médecine. Nous avons cherché à décrire de manière exhaustive l'identité raciale et/ou ethnique, l'identité de genre, l'orientation sexuelle et les capacités des candidats à une seule faculté de médecine canadienne. Nous avons également cherché à établir un lien entre la réussite à chaque étape de la candidature et le sexe et l'identité raciale du candidat ou de la candidate. Méthodes : Les candidats de la promotion 2024 à une faculté de médecine canadienne ont été invités à répondre à une enquête démographique. Les chances d'atteindre chaque étape de la candidature (entrevue offerte, place offerte et inscription) ont été déterminées pour chaque groupe démographique. Résultats : Il y a eu 595 participants (taux de réponse de 32,4 %). Les caractéristiques démographiques des candidats à l’admission et des étudiants admis étaient similaires. Il n'y avait pas de différence entre les candidats blancs et les candidats autochtones, noirs et de couleur (PANDC) en ce qui concerne les offres d'entrevue ou les admissions. Les hommes cisgenres étaient surreprésentés dans les entrevues par rapport aux femmes cisgenres (OR 0,64; 95%CI 0,43-0,95 ; p=0,03) mais pas dans les admissions. Les femmes cisgenres appartenant au groupe des PANDC ont reçu plus d'offres d’entrevue que les autres groupes (OR 2,74, 95%CI 1,20-6,25 ; p=0,02). Conclusions : Les différences les plus marquées dans la réussite des candidats à l’admission parmi les différents groupes démographiques étaient quant aux offres d’entrevue

Point of care ultrasound training needs for primary care physicians: Practice setting matters

Background: Point of care ultrasound (POCUS) is increasingly used in primary care. This study seeks to determine the educational needs of primary care physicians. Methods: All primary care practitioners in Calgary, Alberta, on the electronic departmental newsletter distribution list were invited to participate in an online survey. Interests in learning 25 POCUS applications and 9 procedures were assessed using a 5-point Likert scale. Results: Of the 1394 members on the distribution list, 96 responded. Of these, 88 completed the survey. The majority of the participants (n = 69, 78%) were office-based while 19 (21%) were hospital-based. The top applications for office-based participants included: (1) confirming fetal heart rate, (2) assessing fetal lie, and (3) confirming intrauterine pregnancy. For hospital-based participants, these were: (1) assessing soft tissue/superficial abscesses, (2) looking for ascites, and (3) confirming volume status of the patient. Of the 75 participants who perform procedures, both office- and hospital-based participants were most interested in learning incision and drainage for superficial abscesses and joint aspirations/injections; other procedural interests significantly differed between the two groups. Conclusions: Interests of office-based primary care practitioners in learning POCUS differed significantly from hospital-based practitioners. We recommend that separate office vs. hospital practice streams be offered to address their educational needs

The association between applicant gender and racial or ethnic identity and success in the admissions process at a Canadian medical school: A prospective cohort study

Background: Canadian data suggests that Black candidates may be less successful than other groups when applying to medical school. We sought to comprehensively describe the racial and/or ethnic identity, gender identity, sexual orientation, and ability of applicants to a single Canadian medical school. We also examined for an association between success at each application stage and applicant gender and racial identity.Methods: Class of 2024 applicants to a single Canadian medical school were invited to complete a demographics survey. The odds of achieving each application stage (offered an interview, offered a position, and matriculating) were determined for each demographic group.Results: There were 595 participants (32.4% response rate). The demographics of the applicant pool and matriculating class were similar. There was no difference in interview offers or matriculation between BIPOC and white candidates. Cisgender men were overrepresented in interviews compared to cisgender women (OR 0.64; 95%CI 0.43-0.95; p = 0.03) but not in matriculation. BIPOC cisgender women received more interview invitations compared to other groups (OR 2.74, 95%CI 1.20-6.25; p = 0.02).Conclusions: Differences in applicant success for differing demographic groups were most pronounced being offered an interview.Contexte : Des données canadiennes portent à croire que les candidats noirs peuvent avoir moins de succès que d'autres groupes lorsqu'ils postulent à une faculté de médecine. Nous avons cherché à décrire de manière exhaustive l'identité raciale et/ou ethnique, l'identité de genre, l'orientation sexuelle et les capacités des candidats à une seule faculté de médecine canadienne. Nous avons également cherché à établir un lien entre la réussite à chaque étape de la candidature et le sexe et l'identité raciale du candidat ou de la candidate.Méthodes : Les candidats de la promotion 2024 à une faculté de médecine canadienne ont été invités à répondre à une enquête démographique. Les chances d'atteindre chaque étape de la candidature (entrevue offerte, place offerte et inscription) ont été déterminées pour chaque groupe démographique.Résultats : Il y a eu 595 participants (taux de réponse de 32,4 %). Les caractéristiques démographiques des candidats à l’admission et des étudiants admis étaient similaires. Il n'y avait pas de différence entre les candidats blancs et les candidats autochtones, noirs et de couleur (PANDC) en ce qui concerne les offres d'entrevue ou les admissions. Les hommes cisgenres étaient surreprésentés dans les entrevues par rapport aux femmes cisgenres (OR 0,64; 95%CI 0,43-0,95 ; p=0,03) mais pas dans les admissions. Les femmes cisgenres appartenant au groupe des PANDC ont reçu plus d'offres d’entrevue que les autres groupes (OR 2,74, 95%CI 1,20-6,25 ; p=0,02).Conclusions : Les différences les plus marquées dans la réussite des candidats à l’admission parmi les différents groupes démographiques étaient quant aux offres d’entrevue

Anti-Indigenous bias of medical school applicants: a cross-sectional study

Abstract Background Structural and interpersonal anti-Indigenous racism is prevalent in Canadian healthcare. The Truth and Reconciliation Commission calls on medical schools to address anti-Indigenous bias in students. We measured the prevalence of interpersonal anti-Indigenous bias among medical school applicants to understand how the medical school selection process selects for or against students with high levels of bias. Methods All applicants to a single university in the 2020–2021 admissions cycle were invited to participate. Explicit anti-Indigenous bias was measured using two sliding scale thermometers. The first asked how participants felt about Indigenous people (from 0, indicating ‘cold/unfavourable’ to 100, indicating ‘warm/favourable’) and the second asked whether participants preferred white (scored 100) or Indigenous people (scored 0). Participants then completed an implicit association test examining preferences for European or Indigenous faces (negative time latencies suggest preference for European faces). Explicit and implicit anti-Indigenous biases were compared by applicant demographics (including gender and racial identity), application status (offered an interview, offered admission, accepted a position), and compared to undergraduate medical and mathematics students. Results There were 595 applicant respondents (32.4% response rate, 64.2% cisgender women, 55.3% white). Applicants felt warmly toward Indigenous people (median 96 (IQR 80–100)), had no explicit preference for white or Indigenous people (median 50 (IQR 37–55), and had mild implicit preference for European faces (− 0.22 ms (IQR -0.54, 0.08 ms)). There were demographic differences associated with measures of explicit and implicit bias. Applicants who were offered admission had warmer feelings toward Indigenous people and greater preference for Indigenous people compared to those were not successful. Conclusions Medical school applicants did not have strong interpersonal explicit and implicit anti-Indigenous biases. Outlier participants with strong biases were not offered interviews or admission to medical school

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research