•E-Learning is used among practicing surgeons and proceduralists for continuing professional development .•E-Learning is associated with high satisfaction and improvements in declarative and ...procedural knowledge, and procedural competencies in educational settings.•Future research is required to investigate the impact of E-Learning on workplace-based performance, the health of patients, and community health.
Electronic learning (e-Learning) has become a prevalent mode of delivering medical education. We aimed to determine the learning outcomes and educational effectiveness of e-Learning as a continuing professional development (CPD) intervention for practicing surgeons and proceduralists.
We searched MEDLINE databases and included studies reporting learning outcomes of e-learning CPD interventions for practicing surgeons and physicians performing technical procedures. We excluded articles only studying surgical trainees and those not reporting learning outcomes. Two reviewers independently screened, extracted data, and assessed study quality using the Critical Appraisal Skills Programme (CASP) tools. Learning outcomes and educational effectiveness were categorized using Moore's Outcomes Framework (PROSPERO: CRD42022333523).
Of 1307 identified articles, 12 were included- 9 cohort studies, one randomized controlled trial and 2 qualitative studies, with a total of 2158 participants. Eight studies were rated as moderate, five as strong, and 2 as weak in study quality. E-Learning CPD interventions included web-based modules, image recognition, videos, a repository of videos and schematics, and an online journal club. Seven studies reported participants’ satisfaction with the e-Learning interventions (Moore's Level 2), 4 reported improvements in participants’ declarative knowledge (Level 3a), 1 reported improvements in procedural knowledge (Level 3b) and five reported improvements in participants’ procedural competence in an educational setting (Level 4). No studies demonstrated improvements in participants’ workplace-based performance, the health of patients, or community health (Levels 5−7).
E-Learning as a CPD educational intervention is associated with high satisfaction and improvements in knowledge and procedural competencies of practicing surgeons and proceduralists in an educational setting. Future research is required to investigate whether e-Learning is associated with higher-level learning outcomes.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Aim
Cardiovascular disease (CVD) risk is lower in pre‐menopausal females vs age matched males. After menopause risk equals or exceeds that of males. CVD protection of pre‐menopausal females is ...ascribed to high circulating oestrogen levels. Despite experimental evidence that oestrogen are cardioprotective, oestrogen replacement therapy trials have not shown clear benefits. One hypothesis to explain the discrepancy proposed hearts remodel during peri‐menopause. Peri‐menopasual myocardial changes have never been investigated, nor has the ability of oestrogen to regulate heart function during peri‐menopause.
Methods
We injected female mice with 4‐vinylcyclohexene diepoxide (VCD, 160 mg/kg/d IP) to cause gradual ovarian failure over 120d and act as a peri‐menopausal model
Results
Left ventricular function assessed by Langendorff perfusion found no changes in VCD‐injected mice at 60 or 120 days compared to intact mice. Cardiac myofilament activity was altered at 60 and 120 days indicating a molecular remodelling in peri‐menopause. Myocardial TGF‐β1 increased at 60 days post‐VCD treatment along with reduced Akt phosphorylation. Acute activation of oestrogen receptor‐α (ERα) or ‐β (ERβ) depressed left ventricular contractility in hearts from intact mice. ER‐regulation of myocardial and myofilament function, and myofilament phosphorylation, were disrupted in the peri‐menopausal model. Disruption occurred without alterations in total ERα or ERβ expression.
Conclusions
This is the first study to demonstrate remodelling of the heart in a model of peri‐menopause, along with a disruption in ER‐dependent regulation of the heart. These data indicate that oestrogen replacement therapy initiated after menopause affects a heart that is profoundly different from that found in reproductively intact animals.
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DOBA, FSPLJ, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
Following surgical correction, many patients with esophageal atresia with or without tracheoesophageal fistula (EA/TEF) present to the emergency department (ED) with acute airway complications. We ...sought to determine the incidence and risk factors for severe acute life-threatening events (ALTEs) in pediatric patients with repaired congenital EA/TEF and the outcomes of operative interventions.
A retrospective cohort chart review was performed on patients with EA/TEF with surgical repair and follow-up at a single centre from 2000 to 2018. Primary outcomes included 5-year ED visits and/or hospitalizations for ALTEs. Demographic, operative, and outcome data were collected. Chi-square tests and univariate analyses were performed.
In total, 266 EA/TEF patients met inclusion criteria. Of these, 59 (22.2%) had experienced ALTEs. Patients with low birth weight, low gestational age, documented tracheomalacia, and clinically significant esophageal strictures were more likely to experience ALTEs (p < 0.05). ALTEs occurred prior to 1 year of age in 76.3% (45/59) of patients with a median age at presentation of 8 months (range 0–51 months). Recurrence of ALTEs after esophageal dilatation was 45.5% (10/22), mostly due to stricture recurrence. Patients experiencing ALTEs received anti-reflux procedures (8/59, 13.6%), airway pexy procedures (7/59, 11.9%), or both (5/59, 8.5%) within a median age of 6 months of life. The resolution and recurrence of ALTEs after operative interventions are described.
Significant respiratory morbidity is common among patients with EA/TEF. Understanding the multifactorial etiology and operative management of ALTEs have an important role in their resolution.
Original Research, Clinical Research.
Level III Retrospective Comparative Study.
•The incidence of ALTEs in EA/TEF patients is 22.2% and they mostly occur before age 1-year.•ALTEs are associated with tracheomalacia, esophageal strictures, low birth weight, and low gestational age.•The long-term recurrence of ALTEs after esophageal dilatation, fundoplication, and airway pexy procedures are described.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
All Canadian Residency Matching Service (CaRMS) R1 interviews were conducted virtually for the first time in 2021. We explored the facilitators, barriers, and implications of the virtual interview ...process for the CaRMS R1 match and provide recommendations for improvement.
We conducted a cross-sectional survey study of CaRMS R1 residency applicants and interviewers across Canada in 2021. Surveys were distributed by email to the interviewers, and by email, social media, or newsletter to the applicants. Inductive thematic analysis was used for open-ended items. Recommendations were provided as frequencies to demonstrate strength. Close-ended items were described and compared across groups using Chi-Square Fisher's Exact tests.
A total of 127 applicants and 400 interviewers, including 127 program directors, responded to the survey. 193/380 (50.8%) interviewers and 90/118 (76.3%) applicants preferred virtual over in-person interview formats. Facilitators of the virtual interview format included cost and time savings, ease of scheduling, reduced environmental impact, greater equity, less stress, greater reach and participation, and safety. Barriers of the virtual interview format included reduced informal conversations, limited ability for applicants to explore programs at different locations, limited ability for programs to assess applicants' interest, technological issues, concern for interview integrity, limited non-verbal communication, and reduced networking. The most helpful media for applicants to learn about residency programs were program websites, the CaRMS/AFMC websites, and recruitment videos. Additionally, panel interviews were preferred by applicants for their ability to showcase themselves and build connections with multiple interviewers. Respondents provided recommendations regarding: (1) dissemination of program information, (2) the use of technology, and (3) the virtual interview format.
Perceptions of 2021 CaRMS R1 virtual interviews were favourable among applicants and interviewers. Recommendations from this study can help improve future iterations of virtual interviews.
Concussion prevalence is increasing in the pediatric population, and is a matter of public health concern. Concussion symptoms can be physical, cognitive, emotional and behavioural, and last longer ...in high school aged youth than adults. Concussions are underreported in youth due to their lack of knowledge, social environment, perceived outcomes of reporting, norms, and self-efficacy. The Youth Concussion Awareness Network (You-CAN) is a school-based peer-led program designed to increase high school students' intent to report a concussion, and provide social support to a peer. This study aims to investigate whether participation in You-CAN, a program grounded in service learning principles, impacts concussion knowledge, attitudes, intent to report a suspected concussion to an adult, and intent to provide social support to a peer. Secondary aims include assessing the implementation fidelity and acceptability of the intervention.
This longitudinal study will use a cluster randomized trial design. Three high schools from six randomly selected Canadian school boards will participate and be randomized to three study arms: (1) You-CAN led by school staff; (2) You-CAN led by school staff and research team; and (3) untreated comparison group. Intervention arms 1 and 2 will deliver the You-CAN program and create a Concussion Council at their school. The Concussion Council will deliver a concussion awareness campaign and participate in an online showcase with other participating schools. In addition, arm 2 will have monthly video-calls with the research team. A survey based on the Theory of Planned Behaviour will be administered school-wide with all arms (1, 2, 3) at two time points (beginning {T
} and end {T
} of the school year). Exit interviews will be completed with the Concussion Councils and participating school staff.
This study will provide evidence of the effectiveness of a school-based peer-led concussion program on increasing concussion knowledge, attitudes, subjective norms, perceived behavioural control, intent to report a concussion to an adult, and intent to provide social support to a peer amongst Canadian high school students. It will also provide important information about the implementation and acceptability of the You-CAN program for high school students and staff.
This trial is registered with the ISRCTN registry (ISRCTN64944275, 14/01/2020, retrospectively registered).
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
We performed a systematic review to determine the educational effectiveness of telementoring as a continuing professional development (CPD) intervention for surgeons in practice.
Surgeons can mentor ...their peers in remote locations using videoconferencing communication, referred to as telementoring.
We searched MEDLINE and EMBASE and included studies assessing the educational effectiveness of telementoring interventions used by surgeons in practice. We excluded studies involving only trainees and those not evaluating educational effectiveness. Two reviewers independently screened, extracted data, and assessed study quality using the Medical Education Research Study Quality Instrument (MERSQI; maximum score 18). Educational outcomes were categorized using Moore's Outcomes Framework.
We retrieved a total of 1351 records, and 252 studies were selected for full-text review. Twenty-eight studies were included with 1 randomized controlled trial, 19 cohort studies, 5 qualitative studies, and 3 case studies, totaling 178 surgeons and 499 cases. The average MERSQI score was 10.21 ± 2.2 out of 18. Educational outcomes included surgeons' satisfaction with telementoring interventions (Moore's Level 2) in 12 studies, improvement in surgeons' procedural knowledge (Level 3b) in 3 studies, improvements in surgeons' procedural competence in an educational setting (Level 4) in 4 studies, performance in a workplace-based setting (Level 5) in 23 studies, and patient outcomes (Level 6) in 3 studies. No studies reported community health outcomes (Level 7).
Moderate-level evidence demonstrates the use of telementoring as effective in changing surgeons' knowledge and competence in both educational and workplace-based settings. Its use is also associated with changes in patient outcomes.
We assessed the quality of narrative feedback given to surgical residents during the first five years of Competency-Based Medical Education (CBME) implementation.
CBME requires ongoing formative ...assessments and feedback on learners' performance.
We conducted a retrospective cross-sectional study using assessments of Entrustable Professional Activities (EPAs) in the Surgical Foundations curriculum at Queen's University from 2017-2022. Two raters independently evaluated quality of narrative feedback using the Quality of Assessment of Learning (QuAL) Score (0-5).
A total of 3,900 EPA assessments were completed over 5 years. Fifty-seven percent (2229/3900) of assessments had narrative feedback documented with a mean QuAL score of 2.16±1.49. Of these, 1614 (72.4%) provided evidence about the resident's performance, 951 (42.7%) provided suggestions for improvement, and 499/2229 (22.4%) connected suggestions to the evidence. There was no meaningful change in narrative feedback quality over time (r=0.067, P=0.002). Variables associated with lower quality of narrative feedback include: Attending role (2.04±1.48) compared to medical student (3.13±1.12, P<0.001) and clinical fellow (2.47±1.54, P<0.001), concordant specialties between the assessor and learner (2.06±1.50 vs. 2.21±1.49, P=0.025), completion of the assessment one month or more after the encounter versus one week (1.85±1.48 vs. 2.23±1.49, P<0.001), and resident entrustment versus not entrusted to perform the assessed EPA (2.13±1.45 vs. 2.35±1.66; P=0.008). The quality of narrative feedback was similar for assessments completed under direct and indirect observation (2.18±1.47 vs. 2.06±1.54; P=0.153).
Just over half of the EPA assessments of surgery residents contained narrative feedback with overall fair quality. There was no meaningful change in the quality of feedback over 5 years. These findings prompt future research and faculty development.
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