Kaylee Eady

The hidden and informal curriculum across the continuum of training: A cross-sectional qualitative study.

Abstract Purpose: The hidden and informal curricula refer to learning in response to unarticulated processes and constraints, falling outside the formal medical curriculum. The hidden curriculum has been identified as requiring attention across all levels of learning. We sought to assess the knowledge and perceptions of the hidden and informal curricula across the continuum of learning at a single institution. Methods: Focus groups were held with undergraduate and postgraduate learners and faculty to explore knowledge and perceptions relating to the hidden and informal curricula. Thematic analysis was conducted both inductively by research team members and deductively using questions structured by the existing literature. Results: Participants highlighted several themes related to the presence of the hidden and informal curricula in medical training and practice, including: the privileging of some specialties over others; the reinforcement of hierarchies within medicine; and a culture of tolerance towards unprofessional behaviors. Participants acknowledged the importance of role modeling in the development of professional identities and discussed the deterioration in idealism that occurs. Conclusions: Common issues pertaining to the hidden curriculum exist across all levels of learners, including faculty. Increased awareness of these issues could allow for the further development of methods to address learning within the hidden curriculum.PURPOSE The hidden and informal curricula refer to learning in response to unarticulated processes and constraints, falling outside the formal medical curriculum. The hidden curriculum has been identified as requiring attention across all levels of learning. We sought to assess the knowledge and perceptions of the hidden and informal curricula across the continuum of learning at a single institution. METHODS Focus groups were held with undergraduate and postgraduate learners and faculty to explore knowledge and perceptions relating to the hidden and informal curricula. Thematic analysis was conducted both inductively by research team members and deductively using questions structured by the existing literature. RESULTS Participants highlighted several themes related to the presence of the hidden and informal curricula in medical training and practice, including: the privileging of some specialties over others; the reinforcement of hierarchies within medicine; and a culture of tolerance towards unprofessional behaviors. Participants acknowledged the importance of role modeling in the development of professional identities and discussed the deterioration in idealism that occurs. CONCLUSIONS Common issues pertaining to the hidden curriculum exist across all levels of learners, including faculty. Increased awareness of these issues could allow for the further development of methods to address learning within the hidden curriculum.

Canadian pediatric emergency physician knowledge of concussion diagnosis and initial management.

UNLABELLED Introduction The diagnosis of concussion is a critical step in the appropriate management of patients following minor head trauma. The authors hypothesized that wide practice variation exists among pediatric emergency medicine physicians in the application of physical and cognitive rest recommendations following an acute concussion. METHODS The authors developed a 35-item questionnaire incorporating case vignettes to examine pediatric emergency physician knowledge of concussion diagnosis, understanding of initial management using return-to-play/school/work guidelines, use of existing concussion protocols, and perceived barriers to protocol use. Using a modified Dillman technique, the authors distributed an online survey to members of Pediatric Emergency Research Canada, a national association of pediatric emergency physicians. RESULTS Of 176 potential participants, 115 (65%) responded to the questionnaire, 89% (95% confidence interval [CI]: 0.81, 0.93) of whom reported having diagnosed 20 or more concussions annually. Although 90% (95% CI: 0.83, 0.94) of respondents adequately diagnosed concussion, only 64% (95% CI: 0.54, 0.72) correctly applied graduated return-to-play guidelines. Cognitive rest recommendations were also frequently limited: 40% (95% CI: 0.31, 0.49) did not recommend school absence, 30% (95% CI: 0.22, 0.39) did not recommend schoolwork reduction, and 35% (95% CI: 0.27, 0.45) did not recommend limiting screen time. Eighty percent (95% CI: 0.72, 0.87) of respondents reported having used guidelines frequently or always to guide clinical decisions regarding concussion. CONCLUSION Despite a proficiency in the diagnosis of concussion, pediatric emergency physicians exhibit wide variation in recommending the graduated return to play and cognitive rest following concussion.

The h-index in medical education: an analysis of medical education journal editorial boards

BackgroundDisciplines differ in their authorship and citation practices, thus discipline-specific h-index norms are desirable. Thus the goal of this study was to examine the relationship between the h-index and academic rank in the field of medical education, and the differences in the h-index between MD’s and PhD’s in this field.MethodsDue to the absence of a formalized registry of medical educators, we sampled available editorial board membership (considered a proxy for identifying ‘career’ medical educators) to establish h-index values. These were determined using Web of Science (WoS) and Google Scholar (GS), and internet searching was used to determine their academic rank. The correlation between authors’ h-indices derived from WoS and GS was also determined.Results130 editors were identified (95 full professors, 21 associate professors, 14 assistant professors). A significant difference was noted between the h-indices of full professors and associate/assistant professors (p < .001). Median h-indices equaled 14 for full professors (Interquartile range [IQR] =11); 7 for associate professors (IQR =7) and 6.5 for assistant professors (IQR = 8). h-indices of MD’s and PhD’s did not differ significantly. Moderate correlation between GS and WOS h-indices was noted R = 0.46, p < .001.ConclusionsThe results provide some guidance as to the expected h-indices of a select group of medical educators. No differences appear to exist between assistant professor and associate professor ranks or between MD’s and PhD’s.

A qualitative exploration of which resident skills parents in pediatric emergency departments can assess

Abstract Background: Residents must strive for excellence in their nontechnical skills (NTS). However, NTS have not traditionally been well-assessed in pediatric emergency departments (EDs). One underutilized assessment strategy is to have parents assess the residents caring for their children. Prior to involving parents in resident assessment, it is essential to identify which NTS parents in pediatric EDs can assess. Aim: To explore which resident NTS parents in pediatric EDs can assess. Methods: An exploratory qualitative study design was used. It included interviews with faculty members involved in the supervision and assessment of residents in a pediatric ED and residents who had experience working in a pediatric ED, as well as focus groups with parents who had visited a pediatric ED at least twice in the past year. Results: Participants in this study suggested that parents, if provided with the opportunity, can assess residents’ communication skills, comfort in a pediatric setting, adaptability, and collaboration. Conclusions: This study demystifies how parents can become involved in the assessment of residents’ NTS. The findings will inform the development of assessment strategies and could be used to develop assessment instruments that enable parents to become actively involved in the assessment of residents in pediatric EDs.

Enhancing pediatric residents’ scholar role: the development of a Scholarly Activity Guidance and Evaluation program

Background Research training is essential to the development of well-rounded physicians. Although many pediatric residency programs require residents to complete a research project, it is often challenging to integrate research training into educational programs. Objective We aimed to develop an innovative research program for pediatric residents, called the Scholarly Activity Guidance and Evaluation (SAGE) program. Methods We developed a competency-based program which establishes benchmarks for pediatric residents, while providing ongoing academic mentorship. Results Feedback from residents and their research supervisors about the SAGE program has been positive. Preliminary evaluation data have shown that all final-year residents have met or exceeded program expectations. Conclusions By providing residents with this supportive environment, we hope to influence their academic career paths, increase their research productivity, promote evidence-based practice, and ultimately, positively impact health outcomes.

The development of a TED-Ed online resident research training program

Background Pediatric health research is important for improving the health and well-being of children and their families. To foster the development of physicians’ research competencies, it is vital to integrate practical and context-specific research training into residency programs. Purpose To describe the development of a resident research training program at one tertiary care pediatric academic health sciences center in Ontario, Canada. Methods We surveyed residents and pediatricians/research staff to establish the need and content for a resident research training program. Results Residents and resident research supervisors agreed or strongly agreed that research training is important for residents. However, few residents and supervisors believed that their academic health sciences center provided adequate training and resources to support resident research. As such, an online resident research training program was established. Residents and supervisors agreed that the program should focus on the following topics: 1) critically evaluating research literature, 2) writing a research proposal, 3) submitting an application for research funding, and 4) writing a manuscript. Discussion This highly accessible, context-specific, and inexpensive online program model may be of interest and benefit to other residency programs as a means to enhance residents’ scholarly roles. A formal evaluation of the research training program is now underway.

Connecting medical education to patient outcomes: The promise of contribution analysis

Abstract This article presents a promising program evaluation approach, contribution analysis, which can be used to demonstrate the link between medical education programs and patient outcomes. Contribution analysis is a theory-based evaluation approach. It views programs as a part of causal packages that work together with other factors, interventions, and influences to bring about changes in specific outcomes. Although this approach is well suited for evaluating medical education programs, it has not yet been used in this area.

Exploring residents’ reactions to and use of parent feedback in a pediatric emergency department: A grounded theory study

Abstract Background: Competency-based medical education (CBME) involves workplace-based assessment. In pediatrics, patients’ parents can participate in this assessment and generate feedback for residents. Prior to routinely collecting parent feedback, it is important to investigate residents’ perspectives on it. Aim: To explore residents’ reactions to and use of written parent feedback. Methods: Using a grounded theory approach, we interviewed residents who received written parent feedback at the mid- and end-points of a pediatric emergency training rotation. Results: Twenty-five residents participated. The residents reacted positively to the feedback. They thought that it complements educators’ feedback, can elucidate parents’ perspectives and needs, and is something that residents want and need. Although the residents thought that non-specific negative parent feedback is not useful, they believed non-specific positive and constructive parent feedback to be encouraging and useful. They delineated how they use non-specific positive parent feedback to boost their self-confidence and reassure themselves that parents perceive their clinical practices as appropriate. They also elucidated how they use constructive parent feedback to understand what is important to parents, become aware of their own behaviors, and modify their clinical practices. Conclusions: The findings encourage educators in pediatrics to include parents in resident assessment, especially in the CBME era.