COVID-19 and changes to postgraduate medical education in Canada

"Not doing it justice": Perspectives of Recent Family Medicine Graduates on Mental Health and Addictions Training in Residency

OBJECTIVES

Family physicians report feeling inadequately prepared to meet the evolving mental health care needs of the population. Little scholarship exists evaluating the effectiveness of curricula designed to teach mental health and addiction (MH&A) care to family medicine (FM) residents. As such, the purpose of this study was to explore the experiences of recent FM residency graduates in providing mental health care, and their perceptions of mental health training gaps during their residencies.

METHODS

A qualitative descriptive study design was conducted by 8 recent graduates of the University of Toronto's FM residency program, who participated in semi-structured video interviews. A thematic analysis approach was used to collect and analyze the data.

RESULTS

Through thematic analysis, 3 overarching themes were developed: (1) barriers in providing mental health and addiction care, (2) curriculum renewal, and (3) the role of FPs and professional identity. Consistent with the literature, the majority of recent FM graduates expressed discomfort when managing patients with mental health and addiction concerns. Additionally, participants perceived residency program time constraints, rotational site differences, and limited exposure to marginalized populations all impacted learning and mastery of skills.

CONCLUSION

The findings of this study underscore current gaps within the FM residency curriculum and highlight the need to address current curricular deficits.

Is Virtual Learning Here to Stay? A Multispecialty Survey of Residents, Fellows, and Faculty

The transition to virtual learning during the coronavirus disease 2019 pandemic marks a paradigm shift in graduate medical education (GME). From June to September 2021, we conducted a dual-center, multispecialty survey of residents, fellows, and faculty members to determine overall perceptions about virtual learning and assess its benefits, drawbacks, and future role in GME. We discovered a mainly positive view of virtual education among trainees (138/207, 0.67, 95% CI 0.59-0.73) and faculty (180/278, 0.65, 0.59-0.70). Large group sessions, such as didactic lectures, grand rounds, and national conferences, were ranked best-suited for the virtual environment, whereas small groups and procedural training were the lowest ranked. Major benefits and drawbacks to virtual learning was identified. A hybrid approach, combining in-person and virtual sessions, was the preferred format among trainees (167/207, 0.81, 0.75-0.86) and faculty (229/278, 0.82, 0.77-0.87). Virtual learning offers a valuable educational experience that should be retained in postpandemic GME curriculums.

Exploring Virtual Teaching Approaches Among Pediatricians During the SARS-CoV-2 Pandemic: A Virtual Ethnographic Study

INTRODUCTION

During the SARS-CoV-2 pandemic, Canadian postsecondary institutions were forced to rely on online teaching to comply with physical distancing recommendations. This sole reliance on virtual methods to deliver synchronous teaching sessions in medical education was novel. We found little empirical research examining pediatric educators' experiences. Hence, the objective of our study was to describe and gain a deeper understanding of pediatric educators' perspectives, focusing on the research question, "How is synchronous virtual teaching impacting and transforming teaching experiences of pediatricians during a pandemic?"

METHODS

A virtual ethnography was conducted guided by an online collaborative learning theory. This approach used both interviews and online field observations to obtain objective descriptions and subjective understandings of the participants' experiences while teaching virtually. Pediatric educators (clinical and academic faculty) from our institution were recruited using purposeful sampling and invited to participate in individual phone interviews and online teaching observations. Data were recorded and transcribed, and a thematic analysis was conducted.

RESULTS

Fifteen frontline pediatric teachers from our large Canadian research-intensive university were recruited. Four main themes, with subthemes, emerged: (1) the love/hate relationship with the virtual shift; (2) self-imposed pressure to increase virtual engagement; (3) looking back, moving forward; (4) accelerated adaptation and enhanced collaboration.

CONCLUSION

Pediatricians adopted new delivery methods quickly and found many efficiencies and opportunities in this shift. Continued use of virtual teaching will lead to increased collaboration, enhanced student engagement strategies, and blending the advantages of virtual and face-to-face learning.

Survey of Canadian urology residency programs: Perception of virtual education during the COVID-19 pandemic and beyond

INTRODUCTION

The COVID-19 pandemic has caused many residency programs to pivot from traditional face-to-face to virtual teaching. The objective of this study was to assess the state of virtual education in Canadian urology programs and gauge interest in a national virtual curriculum.

METHODS

An electronic 15-item survey was distributed to all 13 Canadian urology programs' directors and administrative assistants for circulation to residents. Data collection took place over six weeks from September to November 2020. A mixed-methods approach was used, including descriptive statistics and an inductive thematic analysis of responses to open-ended questions.

RESULTS

Eleven program directors and 32 residents from all four geographic areas (Atlantic, Ontario, Quebec, Western [MB, AB, BC]) responded to the survey. Overall, 95.3% of respondents indicated a role for virtual education in their program during the pandemic. Most respondents (74.4%) believe there is a significant or very significant role for a virtual national urology curriculum. All program directors indicated they are at least somewhat likely to require resident participation in such a curriculum. Most (90.6%) resident respondents indicated they believe such a curriculum will be at least somewhat important to their learning. Commonly described benefits include exposure to subspecialties, expertise at other institutions, and standardization of teaching. Commonly described barriers include difficulty with engagement, time zone differences, and lack of dedicated time for attendance.

CONCLUSIONS

During the COVID-19 pandemic, virtual education has become well-integrated in Canadian urology programs. This study highlights interest in the development of a national virtual urology curriculum and puts forth some key considerations to ensure its success.

Online family medicine training amid the COVID-19 crisis in KSA: A mixed-method study

Objective

Literature on the perceptions and experiences of postgraduate trainees and trainers regarding online methods of learning is scarce. We aimed to assess the perceptions and experiences of family medicine trainees and trainers regarding online learning during the novel coronavirus (COVID-19) pandemic in Qassim, KSA.

Methods

This was a mixed-method study involving trainees and trainers at the Family Medicine Academy, Qassim. Quantitative data were collected using structured questionnaires from 36 trainees and 26 trainers. Qualitative data were collected through in-depth interviews with trainees (n = 4) and trainers (n = 3). Descriptive analysis was performed on the quantitative data, while thematic analysis was performed on the qualitative data.

Results

Among the trainees, 39% perceived online learning to be less effective than traditional classroom learning. Moreover, 61% and 64% of the respondents were concerned about the motivation and quality of online learning, respectively. Lack of direct contact with other students was the most commonly perceived concern among 80% of trainees. Among the trainers, the majority were either dissatisfied or neutral about participation and interaction, speakers' and students' motivation, the quality of online learning, and the online teaching experience. Qualitative data showed that online methods provide the advantages of learning from other institutions and flexibility, as well as a viable alternative during crises. However, there were issues with interaction, participation, and trainers' online teaching skills.

Conclusion

Online learning has provided an opportunity to continue training during the COVID-19 crisis. However, there are widespread concerns regarding its effectiveness among trainees and trainers. There is a need to train trainers in online teaching and adopt interactive methods to increase trainees' interaction, motivation, and participation.

A practical guide for translating in-person simulation curriculum to telesimulation

This article provides a road map, along with recommendations, for the adoption and implementation of telesimulation at a large scale. We provide tools for translating an in-presence simulation curriculum into a telesimulation curriculum using a combination off-the-shelf telecommunication platform. We also describe the roles and tasks that emerged within the simulation team when planning and delivering a telesimulation curriculum.

[Teaching in a pandemic: the transformation of teaching and clinical supervision]

INTRODUCTION

The COVID-19 pandemic is an event that deeply impacts our personal, professional, and collective lives. How do we teach in these times of great upheaval? What are the main changes that have occurred?

METHOD

Using the Cartel logic, four professors and a qualitative researcher carried out an autoethnographic research aimed at documenting the main changes that have occurred in the teaching of family medicine in their respective practices located in four different academic family medicine groups at the University of Sherbrooke.

RESULTS

Five key moments in teaching that occurred during a pandemic were identified: a) the declaration of a pandemic, b) the approach with the graduating/advanced cohort of residents, c) the anticipation and preparation for the arrival of new residents, d) arrival of first year residents and e) adaptation to the second wave. For each moment, we present the issues encountered in our care and teaching practices under three transversal relational axes: the relationship of humans to their cultural context, the patient-doctor relationship, and the teacher-resident relationship.

CONCLUSION

Our analysis shows that the transmission of medical knowledge and the art of medicine cannot take place without specific attention to the overall cultural context, the contextual relationship of clinical care, and the teaching relationship. Our study also makes it possible to recommend the opening of spaces for reflection and dialogue in our teaching environments.

[Impact of the Covid-19 pandemic on specialized healthcare training in a teaching center]

OBJECTIVE

Evaluation of the impact of the health crisis caused by the Covid-19 pandemic on specialized healthcare training in a teaching center.

METHODS

Cross-sectional descriptive study, by means of an electronic questionnaire sent to 167 residents in June 2020, to evaluate the burden of care, suspension of rotations and Covid-19 symptoms. The impact on the acquisition of professional competencies was measured using a four-level Likert scale (none, a little, quiet, a lot). The profile of acquired competencies was constructed and its association with the professional profile was studied using Generalized Linear Models. The qualitative approach was carried out through an open question on how it influenced their learning and the different categories were extracted through triangulation.

RESULTS

The impact on learning was important for 94.8% of the residents. A total of 81.4% left the rotations they were doing and reported high workload, loss of training opportunities, uncertainty and ethical conflicts. They appreciated significant learning in the competencies of teamwork (93.2%), professionalism (86.2%), ethics (79.9%) and communication (78%). Technical competencies were deficient. The final balance of learning was perceived as positive by 54.4%, especially residents in central services and medical specialties. A total of 67.8% felt overwhelmed at times due to fatigue-emotional impact, care overload, ethical conflicts and lack of resources.

CONCLUSIONS

The Covid-19 pandemic had an exceptional impact on specialized health care training. It is necessary to re-evaluate training programs to ensure the acquisition of the technical competencies that are lacking.

The impacts of the COVID-19 pandemic on the mental health and residency training of family medicine residents: findings from a nationwide cross-sectional survey in Turkey

Background

The COVID-19 pandemic has had a negative impact on resident training in different branches and affected the physical and mental health of frontline residents adversely. This nationwide cross-sectional survey aimed to investigate the effects of the COVID-19 pandemic on family medicine residents in Turkey, including the levels of depression and burnout.

Methods

An anonymous online survey was distributed to all family medicine residents via e-mail and a web link between 28.11.2020 and 12.12.2020. Information on sociodemographic data and the residency programme were evaluated, and factors associated with depression and burnout were examined using the Patient Health Questionnaire-9 (PHQ-9) and the Burnout Measure-Short Version (BMS) respectively.

Results

Although the weekly average working hours of the 477 respondents increased significantly during the pandemic (p < 0.05), the average weekly working time in the Family Medicine (FM) outpatient clinic decreased. The greatest concern of 58.3% of the residents was fear of transmitting COVID-19 to their family members. 90.2% of the residents stated that training programmes were negatively or very negatively affected. According to PHQ-9 scores, 15.7% of residents had moderately severe, and 14.9% severe depression. The BMS scores of the residents demonstrated that 24.1% had a very severe burnout problem, and 23.3% should seek professional help as soon as possible. Being single, having no children, female gender, lack of personal protective equipments and increased contact time with COVID-19 patients were associated with higher scores in the depression and burnout scales (p < 0.05).

Conclusions

The COVID-19 pandemic has had a negative impact on training programmes for FM residents, who are at the forefront of the pandemic in Turkey, and this situation is closely related to depression and burnout. Due to the unpredictability of the pandemic, long-term plans should be made for the training needs of residents in order to protect their physical and mental health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-021-01576-9.

The impact of the COVID-19 pandemic on Polish orthopedics, in particular on the level of stress among orthopedic surgeons and the education process

The Coronovirus Disease 2019 –(COVID-19) pandemic had a significant impact on the health care system and medical staff around the world. The orthopedic units were also subject to new restrictions and regulations. Therefore, the aim of our research was to assess how the COVID-19 pandemic affected orthopedic wards in the last year in Poland. We created an online survey, which was sent to 273 members of the Polish Society of Orthopedics and Traumatology. The survey contained 51 questions and was divided into main sections: Preparedness, Training, Stress, Reduction, Awareness. A total of 80 responses to the survey were obtained. In Preparedness section the vast majority of respondents (90%) replied, that they used personal protective equipment during the pandemic, however only 50% of the respondents indicated that their facility received a sufficient amount of personal protective equipment. Most of the respondents indicated that the pandemic negatively affected the quality of training of future orthopedists (69.4%) and that pandemic has had a negative impact on their operating skills (66,7%). In Reduction section most of the doctors indicated that the number of patients hospitalized in their departments decreased by 20–60% (61,2% respondents), while the number of operations performed decreased by 60–100% (60% respondents). The negative impact of pandemic on education was noticeable especially in the group of young orthopedic surgeons: 0–5 years of work experience (p = 0,029). Among the respondents, the level of stress increased over the last year from 4.8 to 6.9 (p <0.001). The greatest increase in the level of stress was observed among orthopedists working in country hospitals (p = 0,03). In section Awareness 36,3% of respondents feel well or very well informed about the latest Covid-19 regulations. In addition, most doctors (82.6%) believe that the Polish health care system was not well prepared to fight the pandemic and that the regulations applied so far are not sufficient to effectively fight the pandemic (66.2%). The COVID-19 pandemic has impact on orthopedics departments in Poland and negatively affected the quality of training of orthopedic surgeons and the level of stress.

Advanced Trauma Life Support Course Delivery: Comparison of Outcomes From Modifications During Covid-19

Introduction The Advanced Trauma Life Support (ATLS) Course is a two-day long medical training course developed by the American College of Surgeons (ACS) to help train and prepare healthcare providers to care for severely injured patients. The coronavirus disease 2019 (COVID-19) pandemic has resulted in the modification or cancellation of many education programs across the world. At the University of South Florida's Center for Advanced Medical Learning and Simulation (CAMLS) two different models of ATLS were delivered in response to the COVID-19 pandemic with both models utilizing the ACS's online mobile ATLS (mATLS). In this study three different models of ATLS delivered by USF CAMLS between 2019 and 2020 were compared to determine if there were any impacts on the education and functionality of the ATLS course between the three different models of ATLS: a baseline ATLS course, an augmented ATLS course that used mATLS, and an ATLS course that used mATLS as a replacement for in-person lectures. Material and methods To compare the three models of ATLS delivery, a total of six ATLS courses were studied: a baseline face-to-face ATLS course from June 2019, two Mobile ATLS (mATLS) courses from September 2020, and three augmented ATLS courses that contained both face-to-face and mATLS delivery from October, November and December 2020. The only differences between the traditional ATLS courses from 2020 and the pre-COVID ATLS course from 2019 were that the courses from 2020 utilized mATLS and that the course days were longer due to cleaning time. These courses were selected to have a non-significant difference in the number of learners in each model of ATLS course. The data that were collected from these courses included: post-test results from learners, learner feedback surveys, and interviews with the ATLS Course Director, ATLS Course Coordinator, and the Educational Coordinator. Results The only courses with significant differences in the post-test mean scores were for the baseline ATLS course compared to the mATLS courses. The augmented courses showed similar post-test performance to the mATLS courses. Students viewed the courses favorably with the only major complaint between the 2019 and the 2020 courses being a high amount of downtime for the 2020 courses due to time required to disinfect skill stations and equipment. The main difficulties for the ATLS Course Director, ATLS Course Coordinator, and the Educational Coordinator with the ATLS courses in 2020 were concerned with challenges from COVID-19, like social distancing, and not with mATLS or the shortened instruction time with the hybrid model. Discussion This preliminary study analyzed three delivery models of ATLS. The mATLS may be able to replace in-person lectures of ATLS courses as courses using alternative delivery formats showed post-test scores as good or better than the baseline face-to-face course.

Impact of COVID-19 Pandemic on Post-Graduate Medical Education and Training in India: Lessons Learned and Opportunities Offered

Hands-on or practice-based learning is the foundational objective of postgraduate teaching and training. A skilled and competent postgraduate resident is critical to the country's health needs and is more relevant in the ongoing COVID-19 pandemic. The postgraduate medical training in India is speciality-specific and based on a structured curriculum and syllabus to achieve precise educational goals and objectives. The impact of this pandemic on postgraduate medical education and training is controversial, challenging, unknown, and far-reaching. The exceptional contagious nature of the virus and country-wide lockdowns have tremendously decreased hospital visiting patients. Abolition of outpatient and inpatient services, disruptions in clinical postings, curtailment of elective operations and procedures have adversely affected the training of residents and fellowship students in India and abroad. Apart from this, research work, mentoring, academic conferences, and workshops that offer learning experiences to these residents have been cancelled or suspended, thus denying them a chance to achieve domain knowledge and enhance their skills. Although this pandemic has offered new learning modes like teleconsultation, videoconferencing, virtual simulations, digital podcasts, etc., how much actual knowledge transfer and skill gain will be achieved is unanswered. Despite this disruption, this pandemic has offered a golden opportunity to relook at the current PG resident education and training programme. The lessons learned from this adversity offer medical universities, medical educators, and regulatory authorities many opportunities to develop a novel and innovative curriculum that enables the current and future residents to achieve the necessary proficiency and competency.

Immersive Virtual Reality for Surgical Training: A Systematic Review

BACKGROUND

Immersive virtual reality (iVR) simulators provide accessible, low cost, realistic training adjuncts in time and financially constrained systems. With increasing evidence and utilization of this technology by training programs, clarity on the effect of global skill training should be provided. This systematic review examines the current literature on the effectiveness of iVR for surgical skills acquisition in medical students, residents, and staff surgeons.

METHODS

A literature search was performed on MEDLINE, EMBASE, CENTRAL, Web of Science and PsycInfo for primary studies published between January 1, 2000 and January 26, 2021. Two reviewers independently screened titles, abstracts, and full texts, extracted data, and assessed quality and strength of evidence using the Medical Education Research Quality Instrument (MERSQI) and Cochrane methodology. Results were qualitatively synthesized, and descriptive statistics were calculated.

RESULTS

The literature search yielded 9650 citations, with 17 articles included for qualitative synthesis. The mean (SD) MERSQI score was 11.7 (1.9) out of 18. In total, 307 participants completed training in four disciplines. Immersive VR-trained groups performed 18% to 43% faster on procedural time to completion compared to control (pooled standardized mean difference = -0.90 [95% CI=-1.33 to -047, I²=1%, P < 0.0001]). Immersive VR trainees also demonstrated greater post-intervention scores on procedural checklists and greater implant placement accuracy compared to control.

CONCLUSIONS

Immersive VR incorporation into surgical training programs is supported by high-quality, albeit heterogeneous, studies demonstrating improved procedural times, task completion, and accuracy, positive user ratings, and cost-effectiveness.

Impact of COVID-19 on Canadian Medical Education: Pre-clerkship and Clerkship Students Affected Differently

The coronavirus pandemic (COVID-19) has altered the undergraduate learning experience for many students across Canada. Medical education is no exception; clinical programs, in-person lectures, and mandatory hands-on activities have been suspended to adhere to social distancing guidelines. As remote teaching becomes the forefront of education, medical curricula have been forced to adapt accordingly in order to fulfill the core competencies of medical training and to provide quality education to medical students. With that in mind, the COVID-19 crisis offers a unique opportunity to evaluate the current "continuity plans" in medical education as they stand. This paper provides the perspective of medical students on how medical education is changing for both pre-clerkship and clerkship students, using their experience at McGill University as an example for the Canadian medical education system. Additionally, we discuss the accommodations put forth by the undergraduate medical education (UGME) office, and reflect on the limitations and sustainable solutions in supporting quality medical education.