Oksana Babenko

Motivations for learning of family medicine residents trained in competency-based education*

Abstract Background and objective: Family physicians regularly encounter clinical uncertainty and ambiguity and thus, are expected to engage in on-going learning to respond to changing needs of family practice. Using Achievement Goal Theory, the objective of this study was to examine motivations for learning of family medicine residents in a competency-based program. Method: This was a cross-sectional study, employing a survey methodology with family medicine residents at the mid-point of training at a Canadian university. Multivariate analyses of variance and covariance were used to examine residents’ goal orientations (performance approach, mastery approach, performance avoidance, mastery avoidance) for the group as a whole and to test for the effects of residents’ gender and program stream (urban/rural), respectively. Results: A total of 52 (67%) residents completed the survey. Overall, residents scored highest on mastery approach and lowest on performance avoidance, thus, exhibiting adaptive motivations for learning. Male residents demonstrated higher levels of performance approach, performance avoidance, and mastery avoidance than female residents. No significant differences in goal orientations were found between urban and rural residents. Conclusions: Family medicine residents trained in the culture of competency-based education appear to be mastery approach oriented. This motivation orientation is critical in the dynamic practice of family medicine and is consistent with the life-long learning mandate of the medical profession.

Using HLM to Explore the Effects of Perceptions of Learning Environments and Assessments on Students’ Test Performance

The study examines the role that perceptions or impressions of learning environments and assessments play in students’ performance on a large-scale standardized test. Hierarchical linear modeling (HLM) was used to test aspects of the Learning Errors and Formative Feedback model to determine how much variation in students’ performance was explained by students’ and school principals’ perceptions of learning environments and assessments. Results from sequential HLM testing indicated that students’ but not principals’ perceptions explained a significant, although modest, amount of the total variation in students’ test performance. These results suggest that when students perceive learning environments to be safe and valuable, and positive assessment activities to be taking place, they tend to perform better on standardized tests than when they perceive learning environments and assessment activities otherwise. These findings provide a rationale for investigating the variables that can help improve students’ perceptions in order to enhance their test performance.

The impact of breast reduction surgery on breastfeeding: Systematic review of observational studies

Background Almost half a million breast reduction surgeries are performed internationally each year, yet it is unclear how this type of surgery impacts breastfeeding. This is particularly important given the benefits of breastfeeding. Objectives To determine if breast reduction surgery impacts breastfeeding success and whether different surgical techniques differentially impact breast feeding success. Methods Databases were searched up to September 5, 2017. Studies were included if they reported the number of women successful at breastfeeding or lactation after breast reduction surgery, and if they reported either the total number of women who had children following breast reduction surgery, or the total number of women who attempted to breastfeed following surgery. Results Of 1,212 studies, 51 studies met the inclusion criteria; they were located worldwide and had 31 distinct breast reduction techniques. The percentage of breastfeeding success among studies was highly variable. However, when analyzed by the preservation of the column of parenchyma from the nipple areola complex to the chest wall (subareolar parenchyma), a clear pattern emerged. The median breastfeeding success was 4% (interquartile range (IQR) 0–38%) for techniques with no preservation, compared to 75% (IQR 37–100%) for techniques with partial preservation and 100% (IQR 75–100%) for techniques with full preservation. Conclusions Techniques that preserve the column of subareolar parenchyma appear to have a greater likelihood of successful breastfeeding. The preservation of the column of subareolar parenchyma should be disclosed to women prior to surgery. Guidelines on the best breast reduction techniques to be used in women of child bearing years may be advantageous to ensure women have the greatest potential for successful breastfeeding after breast reduction surgery.

Contributions of psychological needs, self-compassion, leisure-time exercise, and achievement goals to academic engagement and exhaustion in Canadian medical students

Purpose To investigate the contributions of psychological needs (autonomy, competence, and relatedness) and coping strategies (self-compassion, leisure-time exercise, and achievement goals) to engagement and exhaustion in Canadian medical students. Methods This was an observational study. Two hundred undergraduate medical students participated in the study: 60.4% were female, 95.4% were 20–29 years old, and 23.0% were in year 1, 30.0% in year 2, 21.0% in year 3, and 26.0% in year 4. Students completed an online survey with measures of engagement and exhaustion from the Oldenburg Burnout Inventory–student version; autonomy, competence, and relatedness from the Basic Psychological Needs Scale; self-compassion from the Self-Compassion Scale–short form; leisure-time exercise from the Godin Leisure-Time Exercise Questionnaire; and mastery approach, mastery avoidance, performance approach, and performance avoidance goals from the Achievement Goals Instrument. Descriptive and inferential analyses were performed. Results The need for competence was the strongest predictor of student engagement (β= 0.35, P= 0.000) and exhaustion (β= −0.33, P= 0.000). Students who endorsed mastery approach goals (β= 0.21, P= 0.005) and who were more self-compassionate (β= 0.13, P= 0.050) reported greater engagement with their medical studies. Students who were less self-compassionate (β= −0.32, P= 0.000), who exercised less (β= −0.12, P= 0.044), and who endorsed mastery avoidance goals (β= 0.22, P= 0.003) reported greater exhaustion from their studies. Students’ gender (β= 0.18, P= 0.005) and year in medical school (β= −0.18, P= 0.004) were related to engagement, but not to exhaustion. Conclusion Supporting students’ need for competence and raising students’ awareness of self-compassion, leisure-time exercise, and mastery approach goals may help protect students from burnout-related exhaustion and enhance their engagement with their medical school studies.

In sport and now in medical school: examining students’ well-being and motivations for learning

Objectives To investigate relationships between students’ past level of involvement in physical activity/sport and their motivations for learning (achievement goals) and well-being in medical school. In doing so, we provide evidence to medical programs to inform admission processes and curriculum planning. Methods A cross-sectional study was conducted. Out of 640 medical students, 267 completed an online questionnaire with measures of: achievement goals, academic burnout, physical activity/sport involvement, and demographics. Data were analyzed using descriptive and inferential statistics (frequency, mean, standard deviation, chi-square test, Cronbach alpha, Spearman correlation). Results Students who had pursued physical activity/sport at higher levels of involvement had lower academic burnout scores and endorsed maladaptive achievement goals to a less degree. Specifically, the level of students’ involvement in physical activity/sport was negatively correlated with academic burnout (r=-0.15, p=0.014) and with achievement goals of performance approach (r=-0.15, p=0.014), performance avoidance (r=-0.21, p=0.001), and mastery avoidance (r=-0.24, p<0.001). Conclusions Pursuit of dedicated personal activities such as sport appears to be associated with the desired quality of motivation and well-being of medical students. A school culture that fosters resilience of newly admitted students through extracurricular activities and raises students’ awareness of maladaptive and adaptive achievement goals is likely to be beneficial in addressing academic burnout and improving the mental health of medical students.

Evaluation of thyroid test utilization through analysis of population-level data

Abstract: Background: Inappropriate laboratory test utilization can result in unnecessary patient testing and increased healthcare costs. While several thyroid function tests are available, thyroid-stimulating hormone (TSH) is recommended as the first-line test for investigating and monitoring thyroid dysfunction. We evaluate thyroid test utilization in Northern Alberta in terms of testing patterns, frequencies, and reflex cutpoints. Methods: This retrospective study analyzed thyroid test requests from January to December 2014. Each request was designated as appropriate or potentially inappropriate as per clinical practice guidelines and Choosing Wisely recommendations, and the frequencies of each testing pattern were calculated. Sub-analysis was performed to categorize testing patterns based on physician specialty. The number of test requests per patient was determined to assess the appropriateness of testing frequency. Receiver operating characteristic (ROC) curves were generated to define optimal TSH cutpoints for automatic reflex to FT4 testing. Results: Of 752,217 test requests, approximately 10% were potentially inappropriate in terms of testing patterns. Free thyroxine (FT4) and free triiodothyronine (FT3) requested with TSH accounted for 59% of all potentially inappropriate test requests, and 49% of requests from endocrinologists (ENDO) were potentially inappropriate, occurring most frequently among those with less experience. Excessive testing frequencies were observed in 869 patients, accounting for 9382 test requests. Adjustment of our TSH reflex cutpoint would significantly increase specificity for identifying a low FT4 without compromising sensitivity. Conclusions: This study suggests that questionable testing patterns, excessive testing frequencies, and suboptimal reflexive testing cutpoints contribute to inappropriate thyroid test utilization.

Influence of School Year on Seasonality of Norovirus Outbreaks in Developed Countries

Factors affecting the seasonal distribution of norovirus outbreaks are not well understood. This study examined whether grade school settings at the start of the school year may be a factor. We searched Ovid Medline from January 2002 to June 2014 for studies that provided all reported norovirus outbreaks in a developed country by month for a minimum of three years. Historical school years were obtained from verifiable sources. The start of the norovirus seasonal outbreak peak and peak outbreak month were determined for each study and compared to the start month of school. Northern hemisphere and southern hemisphere countries had a different norovirus seasonality and different school year structures (traditional compared to year round). In the two studies that provided outbreaks by age, outbreaks among children started several months before outbreaks in the adult population. The median number of months between school start and start of the seasonal outbreak peak was two months (interquartile range [IQR] = 2.0–3.0), while the median number of months between school start and peak outbreak month was four months (IQR = 3.0–4.0). These findings suggest the possibility the school setting at the start of the school year may be a factor in the seasonality of norovirus.

Are potentially clinically meaningful benefits misinterpreted in cardiovascular randomized trials? A systematic examination of statistical significance, clinical significance, and authors’ conclusions

BackgroundWhile journals and reporting guidelines recommend the presentation of confidence intervals, many authors adhere strictly to statistically significant testing. Our objective was to determine what proportions of not statistically significant (NSS) cardiovascular trials include potentially clinically meaningful effects in primary outcomes and if these are associated with authors’ conclusions.MethodsCardiovascular studies published in six high-impact journals between 1 January 2010 and 31 December 2014 were identified via PubMed. Two independent reviewers selected trials with major adverse cardiovascular events (stroke, myocardial infarction, or cardiovascular death) as primary outcomes and extracted data on trial characteristics, quality, and primary outcome. Potentially clinically meaningful effects were defined broadly as a relative risk point estimate ≤0.94 (based on the effects of ezetimibe) and/or a lower confidence interval ≤0.75 (based on the effects of statins).ResultsWe identified 127 randomized trial comparisons from 3200 articles. The primary outcomes were statistically significant (SS) favoring treatment in 21% (27/127), NSS in 72% (92/127), and SS favoring control in 6% (8/127). In 61% of NSS trials (56/92), the point estimate and/or lower confidence interval included potentially meaningful effects. Both point estimate and confidence interval included potentially meaningful effects in 67% of trials (12/18) in which authors’ concluded that treatment was superior, in 28% (16/58) with a neutral conclusion, and in 6% (1/16) in which authors’ concluded that control was superior. In a sensitivity analysis, 26% of NSS trials would include potential meaningful effects with relative risk thresholds of point estimate ≤0.85 and/or a lower confidence interval ≤0.65.ConclusionsPoint estimates and/or confidence intervals included potentially clinically meaningful effects in up to 61% of NSS cardiovascular trials. Authors’ conclusions often reflect potentially meaningful results of NSS cardiovascular trials. Given the frequency of potentially clinical meaningful effects in NSS trials, authors should be encouraged to continue to look beyond significance testing to a broader interpretation of trial results.

Training of Specialized Geriatric Physicians to Meet the Needs of an Aging Population—A Unique Care of the Elderly Physician Program in Canada

accepted at the North American Primary Care Research Group 2013 for a poster presentation. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Funded by the Northern Alberta Academic Family Physician Endowment Fund. Author Contributions: LC: conception and design, acquisition of data, interpretation of data, drafting the article, critical revision of the article for important intellectual content, final approval of the version to be published. BD: conception and design, analysis and interpretation of data, critical revision of the article for important intellectual content, final approval of the version to be published. RM: conception and design, analysis and interpretation of data, drafting the article, critical revision of the article for important intellectual content, final approval of the version to be published. OB: analysis and interpretation of data, critical revision of the article for important intellectual content; final approval of the version to be published. JT: conception, drafting the article, critical revision of the article for important intellectual content, final approval of the version to be published. Sponsor’s Role: None.

The roles of basic psychological needs, self-compassion, and self-efficacy in the development of mastery goals among medical students

Abstract Aim: Competency-based medical education aims to foster mastery goals in learners. We examined medical students’ mastery approach (beneficial) and mastery avoidance (maladaptive) goals and their associations with students’ basic psychological needs, self-compassion, and self-efficacy. Methods: This was a cross-sectional study employing an online questionnaire. Two hundred medical students in all four years of the medical program completed the questionnaire, containing measures of mastery goals, basic psychological needs (autonomy, competence, relatedness), self-compassion, and self-efficacy. Regression analyses were performed. Results: Of the three basic psychological needs, the need for competence was significant in explaining both types of mastery goals. Self-efficacy and self-compassion were significant in explaining mastery approach and mastery avoidance goals, respectively. Conclusions: Creating learning environments that are supportive of students’ need for competence, raising students’ awareness of the value of learning from mistakes in competency acquisition, and providing opportunities for students to experience self-efficacy may foster beneficial mastery approach goals in medical students.