Saleem Razack

An item analysis of the COMFORT scale in a pediatric intensive care unit.

Objective The objective of this study was to conduct an item analysis of the COMFORT scale within a sample of critically ill children. The COMFORT scale is a tool that measures eight clinical parameters at the bedside to determine a critically ill child’s level of distress. However, documentation of the reliability and validity of specific components of this instrument has been limited to date. Design This was an observational study. Setting A tertiary care pediatric intensive care unit. Patients A sample of 18 intubated, mechanically ventilated patients. Interventions None. Measurements and Main Results An item analysis of the COMFORT scale was conducted. The scale was used for variable intervals with each child, providing a total of 514 individual completed ratings. These ratings were then submitted to descriptive, correlational, factor, and regression analyses using the Statistical Package for the Social Sciences. The principal finding of this item analysis was that 97% of the total score variance was explained by six of the eight items. In particular, it was remarkable that heart rate and blood pressure demonstrated very limited reliability and validity as determinants of the total COMFORT score. As well, the clinical experience of the investigators with this scale has demonstrated that these two items can be cumbersome to use, given that these parameters are often affected by hemodynamic factors. Conclusions On the basis of these findings, we propose a modified COMFORT scale based on a six-item scoring system. This modified scale would provide a more reliable and valid measure for research as well as clinical purposes, by eliminating two parameters that can be affected by factors other than the child’s level of distress.

Multiple mini‐interviews versus traditional interviews: stakeholder acceptability comparison

Context  The McGill University Faculty of Medicine undertook a pilot, simulation‐based multiple mini‐interview (MMI) for medical school applicant selection, which ran simultaneously with traditional unstructured interviews (all applicants underwent both processes). This paper examines major stakeholder (applicants and evaluators) opinions towards the MMI compared with traditional interviews, including perceptions about the feasibility and utility of the MMI.

Faculty development: if you build it, they will come.

Medical Education 2010: 44: 900–907

Seeking inclusion in an exclusive process: discourses of medical school student selection

Calls to increase medical class representativeness to better reflect the diversity of society represent a growing international trend. There is an inherent tension between these calls and competitive student selection processes driven by academic achievement. How is this tension manifested?

Calling for a broader conceptualization of diversity: surface and deep diversity in four Canadian medical schools.

Purpose Policy groups recommend monitoring and supporting more diversity among medical students and the medical workforce. In Canada, few data are available regarding the diversity of medical students, which poses challenges for policy development and evaluation. The authors examine diversity through a framework of surface (visible) and deep (less visible) dimensions and present data regarding a sample of Canadian medical students. Method Between 2009 and 2011, nine cohorts from four Canadian medical schools completed the Health Professions Student Diversity Survey (HPSDS) either on paper or online. Items asked each participant’s age, gender, gender identity, sexual identity, marital status, ethnicity, rural status, parental income, and disability. Data were analyzed descriptively and compared, when available, with national data. Results Of 1,892 students invited, 1,552 (82.0%) completed the HPSDS. Students tended to be 21 to 25 years old (68.3%; 1,048/1,534), female (59.0%; 902/1,529), heterosexual (94.6%; 1,422/1,503), single (90.1%; 1,369/1,520), and unlikely to report any disability (96.5%; 1,463/1,516). The majority of students identified with the gender on their birth certificate (99.8%; 1,512/1,515). About half had spent the majority of their lives in urban environments (46.7%; 711/1,521), and most reported parental household incomes of over

Evaluation of a sedation protocol for intubated critically ill children.

100,000/year (57.6%; 791/1,373). Overall, they were overrepresentative of higher-income groups and underrepresentative of populations of Aboriginal, black, or Filipino ethnicities in Canada. Conclusions The authors propose the development of a National Student Diversity Database to support both locally relevant policies regarding pipeline programs and an examination of current application and selection procedures to identify potential barriers for underrepresented students.

Coming of age as communicators: differences in the implementation of common communications skills training in four residency programmes

The aim of this study was to conduct an evaluation of a sedation protocol that transfers some decision-making authority for analgesia and sedation, within clearly defined parameters, to nurses in a pediatric intensive care unit (PICU). The sedation protocol used in this study was appropriate for any age group. The clinical course of 10 patients admitted to the PICU during a 5-month interval who were on the sedation protocol during their stay was examined using retrospective chart review. Time intervals when patients were on the protocol were compared with clinically comparable time intervals, in terms of acuity, when the same patient received conventional management. Data were collected on the number of days a child was ventilated, the number of days in the PICU, the number of days hospitalized and severity of illness. Additionally, data were collected on the amounts of sedation and analgesia required and the incidence of under-sedation. Physician and nurse satisfaction with the sedation protocol was examined using a self-report survey. The findings of this study indicate that the delegation of decision-making authority for analgesia and sedation to PICU nurses can provide effective and timely management of patient comfort, without an increase in morbidity, in a manner that is more satisfying for physicians and nurses.

faculty and student support: Faculty development: if you build it, they will come

Objectives  To determine thematic similarities and differences in the implementation of common‐content communications skills training (CST) in medicine, surgery, paediatrics, and obstetrics and gynaecology residency programmes.

Acceptability and reliability of multiple mini interviews for admission to otolaryngology residency

Medical Education 2010: 44: 900–907

Understanding what residents want and what residents need: the challenge of cultural training in pediatrics

To evaluate the acceptability and reliability of the Multiple Mini Interview (MMI) for the selection of applicants to an Otolaryngology–Head and Neck (OTL–HNS) residency program.