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

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

The Canada-Guyana medical education partnership: using videoconferencing to supplement post-graduate medical education among internal medicine trainees

Background: A Guyana-based, internal medicine (IM) post-graduate medical education program was established in 2013. However, lack of formal teaching sessions are barriers to the program’s success.Objective: To describe the partnership between the University of Calgary and the University of Guyana’s internal medicine residency programs (IMRP). This partnership was created to support the Guyana’s IM academic half-day and is characterized by mutually beneficial, resident-led videoconference teaching sessions.Methods: Calgary medical residents volunteered to create and present weekly teaching presentations to Guyanese residents via videoconference. Questionnaires were completed by Guyanese residents and provided to Calgary residents as feedback on their teaching and presentation skills. A similar survey was completed by Calgary residents.Lessons learned: Twenty-four videoconference teaching sessions were conducted over eight months with a total of 191 and 16 surveys completed by Guyana and Calgary residents, respectively. Over 92% of both Guyana and Calgary residents agreed that the sessions enhanced their learning and over 93% reported increased interest in becoming more involved in international collaborations. 88% of Calgary residents felt the sessions improved their teaching skills.Conclusion: The formation of a resident-led, videoconference teaching series is a mutually beneficial partnership for Canadian and Guyanese medical residents and fosters international collaboration in medical education.

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

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

A Virtual Community of Practice to Introduce Evidence-based Pedagogy in Chemical, Materials, and Biological Engineering Courses

This paper describes a model for a virtual community of practice (VCP) to support faculty efforts to adopt research-based instructional strategies in Chemical, Materials and Biological Engineering courses. The VCP was built on published recommendations for successful faculty development programs. The VCP program began with a 10 week virtual training period for five pairs of VCP leaders, during which they acquired the skills and knowledge needed to lead the faculty VCP. The faculty VCPs focused on one of five technical disciplines and were led by a pair of leaders having expertise in a specific technical focus area as well as in engineering pedagogy. Workshops were held using Internet conferencing software: the first 8 weekly workshops provided training in research-based pedagogy, and the second 8 biweekly workshops supported faculty efforts to implement chosen strategies in their courses. The participants were full-time faculty members with a range of teaching experience and pedagogical expertise, ranging from novice to expert. Improvement was measured via pre/post survey in the areas of familiarity and use of research-based pedagogy, as well as in perceived student motivation. The second part of the paper focuses on the translation of faculty participant experiences from the VCP into the classroom as they implemented a variety of instructional methods in their courses. We describe their approaches and preliminary results using different instructional methods such as flipping the classroom, using game-based pedagogy, promoting positive interdependence in cooperative-learning teams, peer instruction, small group discussion, Process Oriented Guided Inquiry Learning (POGIL), and using Bloom’s Taxonomy to structure a course

Flow-volume loop abnormality detecting a previously unrecognized right upper lobe tracheal bronchus

Tracheal bronchus is a rare anatomic variant in which a bronchus originates from the trachea. Patients may be asymptomatic or present with a variety of respiratory symptoms. We present a case of a patient who presented with a history of poorly controlled asthma and a persistent abnormality of the flow-volume loop. Bronchoscopy revealed a tracheal bronchus with narrowed right-sided bronchial orifices. An unrecognized tracheal bronchus may result in serious complications during elective or emergent endotracheal intubation. Spirometry testing may reveal abnormalities of the flow-volume loop associated with altered airflow. Relying on spirometric values without assessing the shape of the flow-volume loop may lead to misdiagnosis and inappropriate management of lung pathology

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

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

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

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

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

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

Barriers to reducing preoperative testing for low-risk surgical procedures: A qualitative assessment guided by the Theoretical Domains Framework

Introduction While numerous guidelines do not recommend preoperative tests for low risk patients undergoing low risk surgeries, they are often routinely performed. Canadian data suggests preoperative tests (e.g. ECGs and chest x-rays) preceded 17.9%-35.5% of low-risk procedures. Translating guidelines into clinical practice can be challenging and it is important to understand what is driving behaviour when developing interventions to change it. Aim Thus, we completed a theory-based investigation of the perceived barriers and enablers to reducing unnecessary preoperative tests for low-risk surgical procedures in Newfoundland, Canada. Method We used snowball sampling to recruit surgeons, anaesthesiologists, or preoperative clinic nurses. Interviews were conducted by two researchers using an interview guide with 31 questions based on the theoretical domains framework. Data was transcribed and coded into the 14 theoretical domains and then themes were identified for each domain. Results We interviewed 17 surgeons, anaesthesiologists, or preoperative clinic nurses with 1 to 34 years’ experience. Overall, while respondents agreed with the guidelines they described several factors, across seven relevant theoretical domains, that influence whether tests are ordered. The most common included uncertainty about who is responsible for test ordering, inability to access patient records or to consult/communicate with colleagues about ordering decisions and worry about surgery delays/cancellation if tests are not ordered. Other factors included workplace norms that conflicted with guidelines and concerns about missing something serious or litigation. In terms of enablers, respondents believed that clear institutional guidelines including who is responsible for test ordering and information about the risk of missing something serious, supported by improved communication between those involved in the ordering process and periodic evaluation will reduce any unnecessary preoperative testing. Conclusion These findings suggest that both health system and health provider factors need to be addressed in an intervention to reduce pre-operative testing