A pre-clerkship simulation-based procedural skills curriculum: decreasing anxiety and improving confidence of procedural skill performance

Introduction: Pre-clerkship procedural skills training is not yet a standard across Canadian medical school curricula, resulting in limited exposure to procedures upon entering clerkship. While simulated skills training has been documented in the literature to improve performance in technical ability, anxiety and confidence have yet to be investigated despite their documented impact on performance and learning. This study therefore aims to evaluate the effect of pre-clerkship procedural skills training on medical student anxiety and confidence. Methods: A procedural skills training program was designed based on an evidence-based near-peer, flipped classroom model of education. Ninety-two second-year medical students volunteered for the study. Fifty-six were randomized to the training group, and 36 were randomized to the control group. Students in the training group attended seven procedural skills tutorials over seven months. The control group represented the average medical school student without standardized procedural training. Student anxiety and confidence were assessed at the beginning and end of the program using the State Trait Anxiety Inventory and Confidence Questionnaires. Results: Students who participated in the procedural skills program demonstrated greater reductions in their state anxiety and greater improvements in confidence compared to the control group. Conclusion: Longitudinal procedural skills training in the simulation setting has demonstrated improvements in anxiety and confidence among pre-clerkship medical students. These added benefits to training have the potential to ease medical students’ transition into clerkship, while also contributing to a safer and more effective clinical experience. Therefore, future integration of standardized pre-clerkship procedural skills training within medical school curricula should be considered.

What do participants value in a diversity mentorship program? Perspectives from a Canadian medical school

PurposeAs medical schools become increasingly diverse, there is a growing demand for schools to support their equity-seeking students. At the University of Toronto, the diversity mentorship program (DMP) is a new program created to support equity-seeking and diverse medical students in first- and second-year through didactic lectures, networking opportunities and mentorship from senior clinicians. This article aims to share participant perspectives on how diversity-focused mentorship benefits them, perceived barriers and insights for other institutions developing a similar program.Design/methodology/approachUsing a mixed methods design, students and mentors completed semi-structured surveys to assess broad perceptions of their mentorship experiences. Focus groups were conducted with both groups to gain deeper understandings of participants' experiences. The authors performed thematic analysis to identify qualities of successful experiences and barriers to participation.FindingsMost mentors and mentees found the DMP helpful and identified five themes contributing to a positive mentorship experience: (1) accessibility, (2) program diversity focus with clear expectations, (3) career guidance, (4) exposure to different perspectives and (5) community and shared identity. Uncertainty on how to help less assertive mentees, mentorship pair discordance where mentees paired by race did not share racial identities and logistical challenges was identified as barriers to maintaining mentoring relationships.Originality/valueTo the authors’ knowledge, this is the first qualitative study exploring the feelings and impressions of participants in a mentorship program at a medical school addressing the needs of equity-seeking groups. By understanding the characteristics and value of diversity-focused mentorship, this will inform the creation of similar supportive programs across various professional fields at other schools.

When a Canadian is not a Canadian: marginalization of IMGs in the CaRMS match

This paper explores the marginalization experienced by International Medical Graduates (IMGs) in the Canadian Residency Matching Service (CaRMS) Match. This marginalization occurs despite all IMGs being Canadian citizens or permanent residents, and having objectively demonstrated competence equivalent to that expected of a graduate of a Canadian medical School through examinations such as the MCCQE1 and the National Assessment Collaboration OSCE. This paper explores how the current CaRMS Match works, evidence of marginalization, and ethnicity and human rights implications of the current CaRMS system. A brief history of post graduate medical education and the residency selection process is provided along with a brief legal analysis of authority for making CaRMS eligibility decisions. Current CaRMS practices are situated in the context of Provincial fairness legislation, and rationalizations and rationales for the current CaRMS system are explored. The paper examines objective indicators of IMG competence, as well as relevant legislation regarding international credential recognition and labour mobility. The issues are placed in the context of current immigration and education policies and best practices. An international perspective is provided through comparison with the United States National Residency Matching Program. Suggestions are offered for changes to the current CaRMS system to bring the process more in line with legislation and current Canadian value systems, such that “A Canadian is a Canadian.”

The effect of COVID-19 on medical students’ education and wellbeing: a cross-sectional survey

Background: Canadian medical school curriculums have undergone major restructuring during the COVID-19 pandemic. This study’s goal was to assess the perceived impact of COVID-19 on medical students’ education and wellbeing. Methods: An online survey was distributed to Canadian medical students. Descriptive analyses and ANOVAs were used to assess changes in mental health, health habits and quality of education during the pandemic. Results: 248 medical students from 13 schools across Canada participated in this study. 74% reported a reduction in the quality of their education since COVID-19. 58% of students found online to be inferior to in-person teaching. 65% of students had more time for wellness and leisure activities, about half of the cohort felt more depressed (48%) and lonelier (52%). Student’s overall health habits worsened after the start of the pandemic (F=37.4, p < 0.001). Alcohol drinking, time spent seated, and screen time also increased since the pandemic (p < 0.001). During the pandemic, students with a prior history of depression or anxiety expressed increased depressive symptoms (66% vs. 42%, p =0.003), increased anxiety (69% vs. 41%, p < 0001), worse sleep quality (34% vs. 18%, p = 0.031), and poorer quality of life (55% vs. 65%, p = 0.024) versus those with no prior history. Conclusion: Canadian medical student’s education and wellbeing has been negatively impacted during the pandemic.

International training considerations of Canadian Clinician-Scientist Trainees - A national survey

Purpose: Canadian clinician-scientist trainees enrolled in dual degree programs often pursue an extended training route following completion of MD and MSc or PhD degrees. However, the proportion, plans and reasoning of trainees who intend to pursue training internationally following dual degree completion has not been investigated. In this study, we assessed the international training considerations of current clinician-scientist trainees. Methods: We designed an 11-question survey, which was sent out by program directors to all current MDPhD program and Clinician Investigator Program (CIP) trainees. Responses were collected from July 8, 2019 to August 8, 2019. Results: We received a total of 191 responses, with representation from every Canadian medical school and both MD-PhD program and CIP trainees. The majority of trainees are considering completing additional training outside Canada, most commonly post-doctoral and/or clinical fellowships. The most common reasons for considering international training include those related to quality and prestige of training programs. In contrast, the most common reasons for considering staying in Canada for additional training are related to personal and ethical reasons. Irrespective of intentions to pursue international training, the majority of trainees ultimately intend to establish a career in Canada. Conclusion: While most trainees are considering additional training outside of Canada due to prestige and quality of training, the majority of trainees intend to pursue a career as a clinician-scientist back in Canada. Trainees would likely benefit from improved guidance and mentorship on the value of international training, as well as enhanced support in facilitating cross-border mobility.

Survey of Medical Student Empathy at a Canadian Medical School

Purpose: Within a medical context, empathy is defined as "an appropriate understanding and communication of a patient's experience." While it has been established that empathy is an important quality to have as a future doctor, studies have shown that empathy in medical students declines during their clinical years. However, there are no studies to date that evaluate medical student empathy in Canada. Therefore, we aimed to evaluate medical student empathy at McGill University Medical School using the Jefferson Scale of Empathy (JSE). Methods: We used a cross-sectional study design and invited medical students across all 4 years, in October 2019, to complete the JSE. The JSE is a validated psychometric tool that measures empathy at one point in time. The survey was distributed via email and on social media. We offered the chance for participants to win a prize if they completed the survey. Results: A total of 133 students from all 4 years responded, proportionate across each year. Differences in mean questionnaire were not statistically significant for gender (p=0.364), age (p=0.2746) or specialty interest (p=0.436). The ANOVA for differences in year of medical school was significant (p=0.0104). Between groups analysis revealed a statistically significant decrease between Med-2 empathy scores (average score 117.6) and Med-3 (107.5), p<0.01. Conclusion: Our statistical analysis determined that medical students’ empathy declines between the second and third year of medical school in a Canadian context, consistent with global results. This information can help us target changes in the medical curriculum to preserve empathy in students, and prevent this decline, which could then be applied to other medical schools internationally.

Do Medical Students Receive Adequate Otolaryngology Training? A Canadian Perspective

Objectives: Otolaryngology—head and neck surgery (OHNS) training has been found to be underrepresented in medical school curricula. The study aimed to assess (i) students’ clinical OHNS exposure, (ii) their confidence managing OHNS conditions, and (iii) the correlation between OHNS exposure and confidence managing OHNS conditions. Methods: Fourth-year medical students at two Canadian Universities completed a survey assessing baseline characteristics, OHNS training, and confidence managing OHNS conditions. Results: Of 87 returned surveys, 46 students had no clinical OHNS exposure, while 29 felt there was adequate OHNS exposure. The majority of students lacked confidence recognizing conditions requiring emergent referral. Students with greater OHNS training had greater confidence managing OHNS conditions ( r = 0.267, P = .012). Conclusion: The majority of medical students have minimal OHNS exposure. Students with greater OHNS exposure have greater confidence managing OHNS conditions. A review of Canadian medical school curricula is warranted to ensure adequate OHNS exposure.

LO13: Development of a national, standardized simulation case template

Innovation Concept: A major barrier to the development of a national simulation case repository and multi-site simulation research is the lack of a standardized national case template. This issue was recently identified as a priority research topic for Canadian simulation based education (SBE) research in emergency medicine (EM). We partnered with the EM Simulation Education Researchers Collaborative (EM-SERC) to develop a national simulation template. Methods: The EM Sim Cases template was chosen as a starting point for the consensus process. We generated feedback on the template using a three-phase modified nominal group technique. Members of the EM-SERC mailing list were consulted, which included 20 EM simulation educators from every Canadian medical school except Northern Ontario School of Medicine and Memorial University. When comments conflicted, the sentiment with more comments in favour was incorporated. Curriculum, Tool or Material: In phase one we sought free-text feedback on the EM Sim Cases template via email. We received 65 comments from 11 respondents. An inductive thematic analysis identified four major themes (formatting, objectives, debriefing, and assessment tools). In phase two we sought free-text feedback on the revised template via email. A second thematic analysis on 40 comments from 12 respondents identified three broad themes (formatting, objectives, and debriefing). In phase three we sought feedback on the penultimate template via focus groups with simulation educators and technologists at multiple Canadian universities. This phase generated 98 specific comments which were grouped according to the section of the template being discussed and used to develop the final template (posted on emsimcases.com). Conclusion: We describe a national consensus-building process which resulted in a simulation case template endorsed by simulation educators from across Canada. This template has the potential to: 1. Reduce the replication of effort across sites by facilitating the sharing of simulation cases. 2. Enable national collaboration on the development of both simulation cases and curricula. 3. Facilitate multi centre simulation-based research by removing confounders related to the local adoption of an unfamiliar case template. This could improve the rigour and validity of these studies by reducing inter-site variability. 4. Increase the validity of any simulation scenarios developed for use in national high-stakes assessment.