Lines in the sand: pre-interview rank and probability of receiving admission to medical school

Background: We provide an examination of one medical school’s attempt to determine whether their cut-off point for number of interviews offered is congruent with the probability these applicants’ have for admission post-interview. Methods: Offer probability was determined by organizing pre-interview rankings from 2013-2017 (n = 2,659) applicant cohorts into bins of 50 applicants and finding the quotient of successful and total applicants in each bin.A linear-by-linear association Chi-square test and adjusted standardized residuals with an applied Bonferroni correction were used to determine if the observed frequencies in each bin were different than expected by chance. A Spearman Correlation analysis between pre- and post-interview ranks was conducted. Results: All applicants have between a 50.0% and 76.4% chance of admission. Observed frequencies are different than chance (χ(1)=50.835, p<.001), with a significantly greater number of offers seen in the bins between 1 and 100 (p<.001 for both bins). There is a weak positive relationship between pre- and post-rank, rs(2657)= 0.258, p<.001. Conclusion: The results indicate the number of interviews conducted does not exceed a threshold wherein individuals with a relatively low chance of admission are interviewed. Findings are interpreted with respect to ethical resource allocation for both programs and applicants

An examination of Eyal & Hurst’s (2008) framework for promoting retention in resource-poor settings through locally-relevant training: A case study for the University of Guyana Surgical Training Program

Background: Eyal and Hurst proposed that locally relevant medical education can offset the prevalence of physician “brain drain” in resource-poor regions of the world, and presented a framework of the ethical and pragmatic benefits and concerns posed by these initiatives. The present study explored the framework’s utility through a case study of the University of Guyana Diploma in Surgery (UGDS) programMethods: The framework’s utility was evaluated using a case study designthat included review and analysis of documents and semi-structured interviews with graduates, trainees, faculty members, and policy makers associated with the UGDS program. Data were analyzed from constructivist and interpretivist perspectives, and compared against the benefits and concerns described by Eyal and Hurst.Results: The framework is a useful template for capturing the breadth of experience of locally relevant training in the Guyanese setting. However, the results suggest that delineating the framework factors as either beneficial or concerning may constrict its applicability. The case study design also provided specific insights about the UGDS program, which indicate that the Program has promoted the retention of graduates and a sustainable culture of postgraduate medical education in Guyana.Conclusion: It is suggested that the framework be modified so as to represent the benefits and concerns of locally relevant training along a continuum of advantage. These approaches may help us understand retention within a resource-poor country, but also within particularly remote areas and public health care systems generally

Communication brève sur les perceptions et les comportements postulants potentiels aux études de médecine par rapport à la recherche en lien avec l’admission dans une faculté de médecine canadienne

Background: Aspiring medical students behave based on their perception of what is valued in the selection process. While research experience is not explicitly considered in most Canadian admissions policies, it is commonly held as valuable within aspiring medical student communities. The purpose of this study is to describe the perceptions and behaviours of aspiring medical students with respect to gaining research experience in support of their medical school applications. Methods: We surveyed prospective applicants of Canadian medical schools between August 2021 and November 2021, then compiled descriptive statistics pertaining to their perceptions and behaviours. Results: Respondents affirmed the belief that research experience is valued in medical school admissions processes. They reported spending approximately 13 hours per week engaged in research, which usually did not yield publication or presentation recognition. Conclusion: Aspiring medical students invest substantial time and energy in research experiences to benefit their applications. There is room for medical schools to be more transparent about the value of research experience in their admissions processes.Contexte : Le comportement des candidats aux études de médecine est déterminé par leur perception de ce qui est valorisé dans le processus de sélection. Tandis que la plupart des établissements canadiens ne mentionnent pas explicitement l’expérience en recherche comme prérequis d’admission, les futurs candidats, eux, voient une telle expérience comme un atout précieux. L’objectif de cette étude est de décrire les perceptions et les comportements des futurs étudiants en médecine par rapport à l’acquisition d’une expérience en recherche en appui à leur demande d’admission dans une école de médecine. Méthodes : Nous avons interrogé des postulants potentiels aux programmes de médecine au Canada entre août 2021 et novembre 2021, et nous avons compilé des statistiques descriptives relatives à leurs perceptions et à leurs comportements. Résultats : Les répondants ont affirmé croire que l’expérience en recherche est valorisée dans les processus d’admission aux facultés de médecine. Ils ont déclaré consacrer environ 13 heures par semaine à la recherche, qui, le plus souvent, n’a pas mené à des publications ou des présentations. Conclusion : Les futurs candidats aux études de médecine investissent beaucoup de temps et d’énergie dans des activités de recherche afin d’améliorer leur dossier de candidature. Les facultés de médecine devraient se prononcer de manière transparente sur l’importance attribuée à l’expérience en recherche dans le cadre de leur processus d’admission

The relationship between regional medical campus enrollment and rates of matching to family medicine residency

Background: The Michael G. DeGroote School of Medicine expanded its medical education across three campus sites (Hamilton, Niagara Regional and Waterloo Regional) in 2007. Ensuring the efficacy and equivalency of the quality of training are important accreditation considerations in distributed medical education.  In addition, given the social accountability mission implicit to distributed medical education, the proportion of learners at each campus that match to family medicine residency programs upon graduation is of particular interest. Methods: By way of between campus comparisons of Canadian Residency Matching Service (CaRMS) match rates, this study investigates the family medicine match proportion of medical students from McMaster’s three medical education campuses. These analyses are further supported by between campus comparisons of Personal Progress Index (PPI), Objective Structured Clinical Examination (OSCE), Medical Council of Canada Qualifying Examination-Part 1 (MCCQE1) performances that offer insight into the equivalency and efficacy of the educational outcomes at each campus. Results: The Niagara Regional Campus (NRC) demonstrated a significantly greater proportion of students matched to family medicine. With respect to education equivalency, the proportion of students’ PPI scores that were more than two SD below the mean was comparable across campuses.  OSCE analysis yielded less than 2% differences across campuses with no differences in the last year of training.  The MCCQE1 pass rates were not statistically significant between campuses and there were no differences in CaRMS match rates. With respect to education efficacy, there were no differences among the three campuses’ pass rates on the MCCQE1 and CaRMS match rates with the national rates. Conclusions: Students in all campuses received equivalent educational experiences and were efficacious when compared to national metrics, while residency matches to family medicine were greater in the NRC. The reasons for this difference may be a factor of resident and leadership role-models as well as the local hospital and community environment

Recherche interinstitutionnelle en éducation fondée sur des données : valeurs consensuelles, principes et recommandations pour guider le partage éthique des données administratives relatives à l’enseignement médical à des fins de recherche au Canada

Background: Administrative data are generated when educating, licensing, and regulating future physicians, but these data are rarely used beyond their pre-specified purposes. The capacity necessary for sensitive and responsive oversight that supports the sharing of administrative medical education data across institutions for research purposes needs to be developed. Method: A pan-Canadian consensus-building project was undertaken to develop agreement on the goals, benefits, risks, values, and principles that should underpin inter-institutional data-driven medical education research in Canada. A survey of key literature, consultations with various stakeholders, and five successive knowledge synthesis workshops informed this project. Propositions were developed, driving subsequent discussions until collective agreement was distilled. Results: Consensus coalesced around six key principles: Establishing clear purposes, rationale, and methodology for inter-institutional data-driven research a priori; informed consent from data generators in education systems is non-negotiable; multi-institutional data sharing requires special governance; data governance should be guided by data sovereignty; data use should be guided by an identified set of shared values; and best practices in research data-management should be applied. Conclusion: We recommend establishing a representative governance body, engaging a trusted data facility, and adherence to extant data management policies when sharing administrative medical education data for research purposes in Canada.Contexte : Des données administratives sont générées dans le cadre de la formation des médecins, d’octroi de permis d’exercice et de réglementation des activités professionnelles, mais ces données sont rarement utilisées au-delà de leurs objectifs prédéfinis. Il convient de créer un système de supervision réactif et sensible aux risques pour permettre le partage de données relatives à l’enseignement médical entre établissements à des fins de recherche. Méthode : Une initiative pancanadienne de recherche de consensus a été réalisée pour parvenir à un accord sur les objectifs, les avantages, les risques, les valeurs et les principes qui devraient sous-tendre la recherche interinstitutionnelle sur l’enseignement médical à l’aide des données existantes. Ce projet s’est appuyé sur une analyse de la littérature scientifique, sur des consultations avec diverses parties prenantes et sur cinq ateliers successifs de synthèse des connaissances. Des discussions ont été menées sur la base de propositions formulées préalablement jusqu’à la cristallisation d’un accord collectif. Résultats : Un consensus s’est dégagé autour de six principes clés : la création a priori d’objectifs, d’une logique et d’une méthodologie clairs pour la recherche interinstitutionnelle fondée sur les données; l’obtention, sans exception, du consentement éclairé des personnes concernées par la collecte de données dans les systèmes d’éducation; la création d’un cadre de gouvernance visant spécifiquement le partage des données entre établissements; le respect, dans ce cadre, de la souveraineté des données; l’utilisation des données fondée sur un ensemble de valeurs partagées; et l’application des meilleures pratiques en matière de gestion des données de recherche

Le Certificat de compétence additionnelle en médecine familiale : une enquête descriptive sur le point de vue des médecins de famille sur les pratiques d'amélioration des compétences au Canada

Introduction: The College of Family Physicians of Canada (CFPC) offers the Certificate of Added Competence (CAC) program to designate a family physician with enhanced skills. In 2015, the College expanded its program to introduce enhanced certification in four new domains: Palliative Care, Care of the Elderly, Sports and Exercise Medicine, and Family Practice Anesthesia. In this study, we elicited perceptions from Canadian family physicians with and without the CAC on practice impacts associated with the program. Methods: Active family physicians in Canada with and without CACs were surveyed between November 2019 to January 2020. Descriptive statistics were generated to describe the perceptions of family physicians regarding the CAC program and its impacts on practice. Results: Respondents agreed with several benefits of the program including enhancing the capacity to deliver comprehensive care, alleviating the burden of patient travel by increasing the availability of care in rural and remote communities, and providing opportunities to engage in various collaborative care models and new leadership roles. All respondents perceived CAC holders to pursue the certificate to meet both professional interests and community needs. Conclusions: There is a need for strong and continued investment in systemic practice improvements that incentivize the delivery of comprehensive family medicine practice.Introduction : Le certificat de compétence additionnelle (CCA) accordé par le Collège des médecins de famille du Canada (CMFC) vise à reconnaître un haut niveau de compétences chez un médecin de famille. En 2015, le Collège a élargi le titre de compétences additionnelles à quatre nouveaux domaines : soins palliatifs, soins aux personnes âgées, médecine du sport et de l'exercice, et anesthésie en médecine familiale. Dans cette étude, nous avons recueilli les perceptions de médecins de famille titulaires et non titulaires d’un CCA sur l’influence de pratiques associées au programme de certification. Méthodes : Des médecins de famille actifs au Canada, titulaires et non titulaires du CCA, ont été interrogés entre novembre 2019 et janvier 2020. Des statistiques descriptives ont été générées pour décrire leurs perceptions concernant le Certificat et ses impacts sur la pratique. Résultats : Les répondants s’entendaient pour reconnaître au CCA plusieurs avantages, notamment le fait d'améliorer la capacité des médecins à fournir des soins complets, de leur offrir la possibilité de s'engager dans divers modèles de soins collaboratifs et de nouveaux rôles de leadership, et d'alléger le fardeau des déplacements des patients en augmentant la disponibilité des soins dans les populations rurales et éloignées. Tous les répondants estiment que les médecins recherchent l’obtention de ce titre de compétence pour répondre à la fois à leurs intérêts professionnels et aux besoins de la collectivité. Conclusions : Il faut investir de manière importante et continue dans des améliorations systémiques qui favoriseront une pratique holistique de la médecine familiale

Impact of attentional focus on motor performance within the context of "early" limb regulation and "late" target control

Directing attention to the effect of one's movement (external focus) has been shown to aid performance compared to directing attention to the movement itself (internal focus). This finding has been predominantly explained by an external focus promoting action planning and automatic movement control, while an internal focus acts to constrain movement (constrained action hypothesis [CAH]). In a separate line of research, the multiple control process model states that early movement phases involve anticipated and feedforward processes, while late movement phases explicitly incorporate external afferent information. We hypothesized that enhanced planning and automatic movement control would manifest from an external/distal focus compared to internal/proximal focus. The present study had participants execute fast and accurate movements to a single target using a digitizing graphics tablet that translated movements to a screen. Participants were instructed to focus on the end target location (external-distal), movement of the cursor (external-proximal), and movement of the limb (internal-proximal). It was found that the external-distal focus generated a shorter time to initiate and execute movements (indicating enhanced movement planning) compared to the external- and internal-proximal conditions. In addition, only the external proximal focus revealed a reduction in spatial variability between peak velocity and movement end (indicating greater online control). These findings indicate that advances in action planning and online control occur when adopting an external-distal focus. However, there were some benefits to online control when adopting an external-proximal focus. We propose that an external-distal focus promotes action-effect principles, where there is a greater contribution of anticipatory feedforward processes that limit the need for late online control

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