13 research outputs found

    Les moments équité, diversité, inclusion pour améliorer les connaissances des médecins leaders en matière d’équité, diversité, inclusion

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    Implication Statement Previous research in our department on equity-deserving groups revealed that physician leaders could improve their understanding of barriers faced by physicians from these groups. We developed EDI Moments, a brief, recurring educational intervention, to raise the EDI literacy of physician leaders in our Department of Medicine. In addition to being considered a good use of time by attendees, EDI Moments have led to new processes and policies to improve EDI in our department. Teams that implement EDI Moments should leverage local EDI expertise and select topics suited for their audience’s baseline knowledge.Énoncé des implications de la recherche Des recherches antérieures menées dans notre département sur les groupes visés par l’équité ont révélé que les médecins leaders avaient une compréhension insuffisante des obstacles auxquels sont confrontés les médecins appartenant à ces groupes. Nous avons créé les Moments EDI, une brève intervention éducative périodique visant à améliorer les connaissances des médecins leaders de notre département en matière d’EDI. Ceux qui y ont assisté estiment que cela a été un bon investissement de leur temps, mais les Moments EDI ont avant tout déclenché l’élaboration de processus et de politiques pour renforcer l’EDI dans le département. Les équipes qui organisent les Moments EDI devraient tirer parti de l’expertise locale en matière d’EDI et choisir des sujets adaptés aux connaissances de base de leur public

    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

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    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

    Using the Revised Cardiac Risk Index to predict major postoperative events for people with kidney failure : An external validation and update

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    Funding Information: T.G.H. is supported by a Kidney Research Scientist Core Education and National Training Program postdoctoral fellowship (cosponsored by the Kidney Foundation of Canada and Canadian Institutes of Health Research) and the Clinician Investigator Program at the University of Calgary. These funding sources had no role in study design, data collection, analysis, reporting, or the decision to submit for publication. Funding Information: Ethics Statement: We followed the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD) checklist19 for prediction-model validation (Supplemental Table S1) and were granted ethics approval by the University of Calgary and the University of Alberta.Preoperative risk-prediction tools that are used to predict risk of perioperative death and CV events, and are supported by North American guidelines, include the revised cardiac risk index (RCRI),5 the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) tool,6,7 and the National Surgical Quality Improvement Program Myocardial Infarction or Cardiac Arrest (NSQIP MICA) tool.8 The RCRI has been recommended over others for use in Canada for all adults over the age of 45 years, and for those aged 18-45 years with CV disease, who are undergoing elective, noncardiac surgery.3 The RCRI incorporates 6 criteria based on surgical and comorbidity characteristics of the patient and derives an estimated probability of postoperative myocardial infarction, cardiac arrest, or death.5 Additionally, the RCRI is used to guide perioperative decision-making.3The Alberta Kidney Disease Network database includes person-level linkages of administrative health data, laboratory data, prescription information, and kidney disease-specific data from the province of Alberta, Canada.17 Alberta has approximately 4.4 million residents, and with universal public health insurance, health data capture is near complete.17,18 From this database, we derived a retrospective cohort of adults with kidney failure who underwent ambulatory or inpatient surgery. We used this cohort to externally validate and examine the performance of the RCRI for this population. We followed the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD) checklist19 for prediction-model validation (Supplemental Table S1) and were granted ethics approval by the University of Calgary and the University of Alberta.Peer reviewedPublisher PD

    Equity, Diversity and Inclusion moments to raise Equity, Diversity and Inclusion literacy among physician leaders

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    Implication StatementPrevious research in our department on equity-deserving groups revealed that physician leaders could improve their understanding of barriers faced by physicians from these groups. We developed EDI Moments, a brief, recurring educational intervention, to raise the EDI literacy of physician leaders in our Department of Medicine. In addition to being considered a good use of time by attendees, EDI Moments have led to new processes and policies to improve EDI in our department. Teams that implement EDI Moments should leverage local EDI expertise and select topics suited for their audience’s baseline knowledge.Énoncé des implications de la rechercheDes travaux antérieurs menées dans notre département sur les groupes visés par l’équité ont révélé que les médecins leaders avaient une compréhension insuffisante des obstacles auxquels sont confrontés les médecins appartenant à ces groupes. Nous avons créé les Moments EDI, une brève intervention éducative périodique visant à améliorer les connaissances des médecins leaders de notre département de médecine d’EDI. Ceux qui y ont assisté estiment que cela a été un bon investissement de leur temps, mais les Moments EDI ont avant tout déclenché l’élaboration de processus et de politiques pour renforcer l’EDI dans le département. Les équipes qui organisent les Moments EDI devraient tirer parti de l’expertise locale en matière d’EDI et choisir des sujets adaptés aux connaissances de base de leur public

    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

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    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

    Barriers and facilitators of following perioperative internal medicine recommendations by surgical teams: a sequential, explanatory mixed-methods study

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    Abstract Background Preoperative medical consultations add expense and burden for patients and the impact of these consults on patient outcomes is conflicting. Previous work suggests that 10–40% of preoperative medical consult recommendations are not followed. This limits measurement of the effect of perioperative medical consultation on patient outcomes and represents a quality gap, given the patient time and healthcare cost associated with consultation. We aimed to measure, characterize, and understand reasons for missed recommendations from preoperative medical consultation. Methods This explanatory, sequential mixed-methods study used chart audits followed by semi-structured interviews. Chart audit of consecutive patients seen in preoperative medical clinic were reviewed to measure the proportion and characterize the type of recommendations that were not completed (“missed”). This phase informed the interview participants and questions. The interview guide was developed using the Consolidated Framework for Implementation Research and the Theoretical Domains Framework. Template analysis was used to understand drivers and barriers of missed recommendations Results Chart audit included 255 patients (n=161, 63.1% female) seen in preadmission clinic between April 1 and April 30, 2019. 55.7% of patients had all recommendations followed (n=142). Postoperative anticoagulation management and postoperative cardiac biomarker surveillance recommendations were least commonly followed (50.0%, n=28, and 68.9%, n=82, respectively). Eighteen surgical team members were interviewed. Missed recommendations were both unintentional and intentional, and the key drivers differed by these categories. Unintentionally missed recommendations occurred due to individual-level factors (drivers: knowledge of the consultation note, lack of routine for reviewing the consultation note, and competing demands on time) and systems-level factors (driver: lack of role clarity). Intentionally missed recommendations occurred due to user error due (drivers: lack of knowledge of guidelines or evidence) and appropriate modifications (driver: need to adapt a preoperative plan for a complicated postoperative course). Conclusions Only 55.7% of consult notes had all recommendations followed, suggesting a quality gap in perioperative medical care. Qualitative data suggests multiple drivers of missed recommendations that should be targeted to improve the efficiency of care for these patients

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

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    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

    Cross-sectional survey on physician burnout during the COVID-19 pandemic in Vancouver, Canada : the role of gender, ethnicity and sexual orientation

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    Objective To determine the prevalence of physician burnout during the pandemic and differences by gender, ethnicity or sexual orientation. Design, setting and participants We conducted a cross-sectional survey (August–October in 2020) of internal medicine physicians at two academic hospitals in Vancouver, Canada. Primary and secondary outcomes Physician burnout and its components, emotional exhaustion, depersonalisation and personal accomplishment were measured using the Maslach Burnout Inventory. Results The response rate was 38% (n=302/803 respondents, 49% women,). The prevalence of burnout was 68% (emotional exhaustion 63%, depersonalisation 39%) and feeling low personal accomplishment 22%. In addition, 21% reported that they were considering quitting the profession or had quit a position. Women were more likely to report emotional exhaustion (OR 2.00, 95% CI: 1.07 to 3.73, p=0.03) and feeling low personal accomplishment (OR 2.26, 95% CI: 1.09 to 4.70, p=0.03) than men. Visible ethnic minority physicians were more likely to report feeling lower personal accomplishment than white physicians (OR 1.81, 95% CI: 1.28 to 2.55, p=0.001). There was no difference in emotional exhaustion or depersonalisation by ethnicity or sexual orientation. Physicians who reported that COVID-19 affected their burnout were more likely to report any burnout (OR: 3.74, 95% CI: 1.99 to 7.01, p<0.001) and consideration of quitting or quit (OR: 3.20, 95% CI: 1.34 to 7.66, p=0.009). Conclusion Burnout affects 2 out of 3 internal medicine physicians during the pandemic. Women, ethnic minority physicians and those who feel that COVID-19 affects burnout were more likely to report components of burnout. Further understanding of factors driving feelings of low personal accomplishment in women and ethnic minority physicians is needed.Medicine, Faculty ofOther UBCNon UBCMedicine, Department ofReviewedFacult

    Beyond guideline knowledge: a theory-based qualitative study of low-value preoperative testing

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    Abstract Background Choosing Wisely Canada and most major anesthesia and preoperative guidelines recommend against obtaining preoperative tests before low-risk procedures. However, these recommendations alone have not reduced low-value test ordering. In this study, the theoretical domains framework (TDF) was used to understand the drivers of preoperative electrocardiogram (ECG) and chest X-ray (CXR) ordering for patients undergoing low-risk surgery (‘low-value preoperative testing’) among anesthesiologists, internal medicine specialists, nurses, and surgeons. Methods Using snowball sampling, preoperative clinicians working in a single health system in Canada were recruited for semi-structured interviews about low-value preoperative testing. The interview guide was developed using the TDF to identify the factors that influence preoperative ECG and CXR ordering. Interview content was deductively coded using TDF domains and specific beliefs were identified by grouping similar utterances. Domain relevance was established based on belief statement frequency, presence of conflicting beliefs, and perceived influence over preoperative test ordering practices. Results Sixteen clinicians (7 anesthesiologists, 4 internists, 1 nurse, and 4 surgeons) participated. Eight of the 12 TDF domains were identified as the drivers of preoperative test ordering. While most participants agreed that the guidelines were helpful, they also expressed distrust in the evidence behind them (knowledge). Both a lack of clarity about the responsibilities of the specialties involved in the preoperative process and the ease by which any clinician could order, but not cancel tests, were drivers of low-value preoperative test ordering (social/professional role and identity, social influences, belief about capabilities). Additionally, low-value tests could also be ordered by nurses or the surgeon and may be completed before the anesthesia or internal medicine preoperative assessment appointment (environmental context and resources, beliefs about capabilities). Finally, while participants agreed that they did not intend to routinely order low-value tests and understood that these would not benefit patient outcomes, they also reported ordering tests to prevent surgery cancellations and problems during surgery (motivation and goals, beliefs about consequences, social influences). Conclusions We identified key factors that anesthesiologists, internists, nurses, and surgeons believe influence preoperative test ordering for patients undergoing low-risk surgeries. These beliefs highlight the need to shift away from knowledge-based interventions and focus instead on understanding local drivers of behaviour and target change at the individual, team, and institutional levels
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