Investigating Emerging Trends and Celebrating New

Discoveries

PLENARY & PRESENTATION

ABSTRACTS

McGill Faculty Club and Conference

Centre May 14, 2020

Richard and Sylvia Cruess Symposium on

Health Sciences Education

INVITED PLENARIES Faculty Club Ballroom

Unspoken or Unspeakable?: A Rhetorician’s Reflections on the Study of Taboo

Topics in Health Sciences Education 9:00 am – 10:00 am Lorelei Lingard

University of Western, Ontario

Our field is currently grappling with a number of taboo topics. By taboo, I intend issues that were hitherto unthinkable as a source of scholarly study and debate in health sciences education (HSE), such as shame, stigma, failure, dishonesty, fraud and greed. Many of these are now being systematically explored by HSE scholars as legitimate matters of concern. Some of this scholarship is being received as innovative, courageous and timely; it is as though speaking the unspoken has awakened an appetite for a long overdue conversation. However, other scholarship is being received as deviant, dangerous, even immoral. In such cases, researchers have invoked something not only conventionally unspoken but currently unspeakable. Rather than being met with enthusiasm, they may be punished (e.g., in public discussions and peer review) for the breaking of a social taboo. Using examples from recent HSE research, this presentation will consider four key questions:

1. What is speakable in one historical context may be unspeakable in another. Why are these taboo topics emerging now in HPE?

2. Why are some of these taboo topics unspoken yet enthusiastically received, while others are unspeakable and punishable?

3. Rhetorical theory tells us that the act of naming something is powerful, and potentially dangerous. What role does language play in the successful study of taboo topics?

4. What taboo topics remain so unspeakable that no HSE research has yet tackled them?

Educating Today’s Health Care Workforce for Tomorrow’s Practice: The

Challenges of Context 1:00 pm – 2:00 pm Fred Hafferty Mayo Clinic, Minnesota USA For the past two decades, scholars and pundits have pointed to the “extraordinary” / “dramatic” /

“unparalleled” changes in the reorganization and delivery of health care. Less well explored, and perhaps

understood, is how these changes (both real and imagined) impact the training of a future health care

workforce given that such training is taking place both in the present and in the context such

change. Using the lens of context and the frame “all practice is local,” we will wrestle with such issues.

CONCURRENT CONVERSATIONS Faculty Club Billiard Room & Ballroom

2:00 pm – 3:00 pm

How Do We Move From Assessing Individual Competence to Assessing Collective

Competence? Billiard Room

Lorelei Lingard

University of Western, Ontario

Most of our assessment practices assume independent, individual performances. But most clinical performances are collaborative and therefore interdependent, with other members of the team, with policies, and with organizational cultures. This seminar will get us thinking beyond the assumption of individual, independent performance, to imagine new assessment models that can better capture teamwork. Participants will be invited to conceptualize a spectrum of trainee performance in their own clinical teaching contexts, from those clinical actions/decisions which are (more) independent to those which are (more) collective. We will then brainstorm ways of assessing that get closer to the interdependent end of that spectrum: what kinds of data are available? What assessment models might help us to gather and interpret those data? Participants will leave with a way of thinking beyond individual competence, and some early ideas for how assessment of collective competence might unfold in their own clinical teaching contexts.

Exploring the Invisible Geography of Medicine’s Modern Day Professionalism

Movement: An Excavation of Impact and Insurrection Ballroom Fred Hafferty Mayo Clinic, Minnesota USA Through a series of interactive group exercises, we will explore how the group - as a collectivity - sees the impact and future directions of what has now been a 25+ year evolution of medicine’s modern day professionalism movement. In doing so, we will also explore U.S and Canadian similarities and differences.

PROFESSIONALISM AND PROFESSIONAL IDENTITY FORMATION Faculty Club Billiard Room

10:30 am – 12:00 pm

The Role of Clinical Teachers in Professional Identity Formation Robert Sternszus, Yvonne Steinert, Donald Boudreau, Richard Cruess, Sylvia Cruess, Mary Ellen Macdonald

McGill University

Innovation: A fundamental goal of medical education is supporting learners in forming a professional

identity. While we know that clinical teachers are perceived by learners as important in this process, this

study sought to understand how clinical teachers perceive their influence on the professional identity

formation of learners.

Methods: A research assistant conducted sixteen semi-structured interviews with clinical teachers from

eight different specialties at McGill University between March and October 2017. They audio-recorded

and subsequently transcribed interviews for analysis following principles of qualitative description.

Results: Participants struggled to describe their influence on learners’ professional identity without first

being prompted to focus on their own identity and its formation. Once prompted, clinical teachers

reported viewing their personal and professional identities as integrated and believing that caring for

patients was integral to forming their professional identity. They identified explicit role modeling,

engaging in difficult conversations, and providing graded autonomy as ways in which they could influence

the identity development of learners. However, they had difficulty discerning the magnitude of their

influence.

Conclusions: This study was the first to explore professional identity formation from the perspective of

practicing clinicians. Our results suggest that if clinical teachers are to effectively support learners in their

formation of a professional identity, they must be given the space and guidance to reflect on this process,

helped in making the implicit explicit, and supported in using their own experiences as learners to inform

their teaching.

Exploring Professional Identity: A Scoping Review in Rehabilitation Professionals Susanne Mak, Matthew Hunt, Jill Boruff, Marco Zaccagnini, Aliki Thomas

McGill University

Innovation: Professional Identity (PI) is believed to foster self-regulation, self-confidence and resilience in

health care professionals. While literature exists describing PI in physicians, the transferability of this

evidence to rehabilitation professionals (RP) is limited. Differences in decision-making power (patient

care) and professional autonomy between professions require knowledge synthesis on the nature and

development of PI in RPs [occupational therapy (OT), physical therapy (PT) and speech-language

pathology (S-LP)].

The goal of this study was to determine the extent, range and nature of the literature on PI and its

development in RPs.

Methods: We will report on the findings of our scoping review based on Arksey and O’Malley’s

methodological framework. These databases were searched: Embase, AMED, CINAHL, ProQuest

Dissertations and Theses, and OVID Medline. Studies of OT, PT, and S-LP clinicians/students (1996-2018)

were included to capture undergraduate and graduate professional programs.

Results: Of 3741 retrieved records, 33 studies (22 OT, 7 PT, 1 S-LP, 3 mixed) were selected for data

extraction by two reviewers. Data were organised into themes for PI/PI development: descriptors (e.g.

multiple identities, students’ pre-existing notions of a profession); influences (e.g. others’ perceptions of

a profession); consequences (e.g. burnout); measurement tools (e.g. quantitative measurement,

comparison); and outcomes of PI (e.g. authenticity).

Conclusions: Our findings are consistent with the PI literature in physicians, but illustrate a need for

further empirical inquiry on the use of PI theoretical frameworks for RPs and in outcomes associated with

PI. Our findings may inform professional training programs, associations and regulatory bodies in

developing resources to support PI in RPs.

Professional Identity During Residency: Workshop Development and Evaluation Hajar El Kamouni, Martin Plaisance

University of Sherbrooke

Background: While the health sciences literature shows that cognitive dissonance between personal and

professional identities is one of the leading causes of burnout and of professional misconduct,

competency-based medical education successfully assesses whether the resident "acts like a good doctor"

while observed. However, this system cannot ensure if the resident will ultimately be a "professionally

engaged doctor." To support residents in their professional identity formation (PIF), we designed a 2-hour

workshop focusing on critical factors in the medical socialization process. The purpose of our research is

to establish whether this activity has positive impacts on PIF among residents in an Internal Medicine

Program.

Innovation: The workshop was conducted in small-group settings of 6 residents and a mentor. The

discussion focused on elements influencing PIF (i.e. personal and professional values, patient-doctor

relationship, stressful events). Participants’ feedback was assessed in the short- and medium-term (within

24-hours and 1-month post-workshop).

Outcomes & Conclusions: With a response rate of 63% (53 residents), 100% of the respondents undertook

personal reflections on their PIF and 77.4% made changes in the perception of their own professional

identity. 100% considered this activity highly relevant and suggested its implementation on an annual

basis. The 1-month questionnaire showed that peer-sharing had a beneficial role in normalization of some

stressful daily concerns. Some respondents even reported positive changes in their behaviors as health

professionals.

Conclusions: By providing residents with opportunities to develop a comprehensive understanding of

socialization, outside usual competency-evaluation settings, this study showed us that PIF during

residency can be positively modulated.

Whole Person Medical Education – The Heart of the Matter Stephen Liben, Tom Hutchinson

McGill University

Background: While we know “the what” that we aspire to teach medical students – to become medical

experts who not only provide excellent care, but are also caring (“patient at heart, science in hand”) - we

know much less about “the how,” How can we educate future physicians to be present, to connect with

themselves, their patients, and their colleagues in ways that promote healing? Why, despite many

technical advances in healthcare, are patients dissatisfied with their doctor-patient encounters, and why

are many physicians burned-out and unhappy? There is a connection between dissatisfied patients and

unhappy doctors that has nothing to do with improved treatments and outcomes but is rather the

consequence of a reductive medical model that fails to recognize the whole personhood of both patient

and doctor.

Innovation: We created the “Mindful Medical Practice (MMP)” course that encompasses the whole

personhood of teacher, student and patient to help address “the how.” A small-group based

undergraduate course given over 7 weeks, MMP has students experience for themselves moments of

“realizations,” such as what it feels like to be truly heard, coupled to instruction on how to manage their

attention to self and others in ways that support the conditions for healing to occur.

Outcomes: The MMP teacher’s course guide has been published (https://bit.ly/2NxTCyL). Based on

published students’ essays, the MMP has positive impacts on 1) students recognition of

attention/awareness as a foundational clinical skill and 2) resilience building capacity.

Conclusions: The MMP course has promise as an intervention in the education of better whole-person

care physicians.

The Jam Session Format for the Ethical Training of Residents: Toward a “Shared

Hands-on Approach” to Professionalism Education Laura Leondina Campanozzi, Vittoradolfo Tambone

University of Rome, Italy

Background: Professionalism education for medical residents has become a topic of interest alongside

the recognition that ethics is one of the essential components for realizing a good medical practice.

Despite evidence that educational needs are context–specific, teaching approaches of professionalism are

still challenging the effort to develop learning experiences useful in supporting residents to undertake

their professional accountability in facing real ethical dilemmas. This work describes an experimental

training approach for residents that has been accomplished at Campus Bio-Medico University of Rome

since May 2016 to develop specific skills regarding judgment in ethical dilemmas and appropriate

standards for clinical professionalism.

Innovation: Drawing upon interesting suggestions from the world of music, specifically from the analysis

of the jazz jam session process, we designed a training format called jam session to emphasize the

cooperation of each other’s capabilities for developing a common outcome.

Outcomes: Based on the presentation and discussion by trainees of real cases arising ethical and

professional issues in the presence of both colleagues and clinical ethics experts, the jam sessions have

been found to be useful to promote in participants the willingness to establish or reframe rationally their

own views, and to take an active part in identifying ethically grounded solutions.

Conclusions: The jam session format can serve as a model for a ‘shared hands-on approach’ to identity

formation, as it allows residents to develop key professional skills in a more personal and sound way while

engaging residents in an immersive and vivid learning experience.

Assessing Professionalism: Not as Difficult as You Might Think! Luce Pélissier-Simard, Shelley Ross, Cheri Bethune, Katherine Lawrence

University of Sherbrooke

Background: Teaching and assessing professional behaviour is crucial in health professions education, yet

clinical teachers often find professionalism to be a challenging topic for feedback and assessment with

learners. Many clinical educators struggle to describe what is a professional behaviour and what is

unprofessional. Learners may lack self-awareness about how their actions are interpreted by those around

them. Addressing professionalism concerns with learners requires appropriate tools and resources so that

learner and observer understand what professional and unprofessional behaviours look like.

Innovation: The College of Family Physicians of Canada (CFPC) has developed a resource for assessing and

addressing professionalism issues with learners as part of the Evaluation Objectives in Family Medicine.

The Professionalism resource was derived from a survey of a representative sample of Canadian family

physicians. Thematic analysis of the survey results was followed by a nominal group process to articulate

twelve themes of professionalism, with accompanying examples of observable behaviours.

Outcomes: The Professionalism observable behaviours provide supervisors and learners with a clear

reference guide to support a shared mental model of professionalism for both teaching and assessment.

Conclusions: This resource is useful for teaching, for supporting learners in understanding professionalism

and carrying out self-assessment of their own professionalism, and as a reference guide for remediation

activities. The observable behaviours resource can also facilitate continuous improvement across the

continuum of training. Examples from different Family Medicine residency programs will be shared.

EDUCATIONAL INNOVATION PART I: INTERDISCIPLINARY INITIATIVES Faculty Club Old McGill Room

10:30 am – 12:00 pm

Exploring Student Nurses’ Experiences in the Anatomy Lab to Support and

Optimize their Learning Rosetta Antonacci, Lianna Marie Curiale, Kathleen Elyse MacMillan, Nicole Ventura

McGill University

Introduction: Human cadaveric-based anatomy learning laboratories in medical curricula is essential for

learning anatomical knowledge, developing professional skills, advancing medical training and fostering

an intellectual relationship with the body. This encounter may lead to feelings of anxiety, moral distress

and fears around death and dying. Although an increase in students’ anxiety levels may enhance creativity

and foster development, when the anxiety level is too intense, students may encounter an increase in

errors and decrease attention, concentration, learning and productivity. These feelings are common for

first time anatomy lab students and with increased exposure to the lab the students may acclimatize to

the situation and better cope with their emotions. Working with human cadavers is a unique opportunity

in nursing and occurs minimally in their undergraduate studies. Exposure to this valued educational

method in nursing and allied health professional schools has received little attention.

Methods: A qualitative descriptive study was conducted to analyze the reflective assignments submitted

by former undergraduate and graduate nursing students enrolled in an inter-professional health and

physical assessment course offered at McGill University. The data source consisted of reflective written

assignments describing their experience in the anatomy learning lab. Content analysis techniques were

used to analyze the data.

Results: In total, 168 assignments were included in the analysis with no student-withdrawing their

assignment from study. Three themes were identified: Coping with the Initial Shock of the Anatomy Lab

Experience, Reflecting on the Salience of Death, and Dying and Acknowledging Impacts on Future Practice.

Conclusions: Students found renewed inspiration and dedication to providing only the best care to their

future patients in honor of their human cadaver donor. The coping strategies learned in the anatomy lab

will follow students into their clinical practice. Educational institutions offering human cadaveric-based

anatomy learning laboratories should ensure adequate exposure to the anatomy lab, and support to their

students before and after the anatomy lab to aid inadequate coping and optimizing learning for their

students.

Evaluating the Integration of Body Donor Imaging into Anatomical Dissection Using Augmented Reality Kimberly McBain, Liang Chen, Angela Lee, Jeremy O’Brien, Geoffroy PJC Noël, Nicole M Ventura McGill University Background: Augmented reality (AR) has recently been utilized as an integrative teaching tool in medical education given its ability to view a virtual world while interacting with the real-world environment. By overlaying diagnostic imaging onto cadaveric specimens using AR, students have the potential to observe anatomical relationships and variations to guide their approach to dissection. The purpose of this mixed methods study was to evaluate the implementation of overlaying donor-specific diagnostic imaging (DSDI)

onto associated cadaveric body donors in a fourth-year, dissection-based, elective course titled Anatomy for Surgeons (AFS). Innovation: AFS students received either DSDI displayed on a Microsoft HoloLens (n=12), or DSDI displayed on an iPad (n=15). To test whether spatial abilities had improved, students completed an anatomical mental rotation test (AMRT) prior to and following the AFS course. Students participated in group interviews and completed a survey after the AFS course addressing dissection experience, DSDI relevancy to dissection, and use of AR in anatomical education. Dissection quality was also assessed. Outcomes: Although significance was not achieved when comparing group AMRT scores, survey and interview data suggested that the HoloLens had improved the students’ understanding, and spatial orientation of, anatomical relationships. The quality of abdomen dissections were also significantly greater for students using the HoloLens. Conclusions: Although difficulties using the HoloLens was mentioned, with faculty assistance and enhanced software development, the potential of this AR tool could contribute to greater dissection quality, an immersive learning experience and help medical trainees better integrate radiology with anatomy.

VAIN: A Vascular Access and Infusion Nursing Curriculum for Bachelor of Science

in Nursing (BScN) Students at McGill University Mélanie Gauthier, Caroline Marchionni

McGill University

Background: The peripheral intravenous catheter (PIV) is ubiquitous in acute care hospitals. However, the

PIV has been the sad victim of neglect, with little systematic attention paid to its insertion, maintenance

and use. The patient with the PIV often experiences premature catheter failure, phlebitis and infection

and must undergo preventable reinsertion. For the student nurse, PIV insertion represents one of the

most stressful skills they must learn. The responsibility to ensure that novice nurses are prepared should

be shared between the educational institution and the employer.

Innovation: The Ingram School of Nursing at McGill University recently underwent a revision of the BScN

program. This presented an opportunity to revise how vascular access and infusion nursing (VAIN),

including PIV management, was taught and evaluated. A literature search and review of the nursing entry-

to-practice competencies was completed, and, with a content expert, the VAIN curriculum was developed

and integrated into the revised program. A research study is ongoing to determine if the integration of

the VAIN curriculum into the revised BScN program positively impacts the knowledge, skills and

confidence of new nursing graduates.

Outcomes: The preliminary results of the pre- and post-implementation assessment of the VAIN

curriculum will be summarized. These results demonstrate the positive impact of a structured curriculum

with clinical simulation and directed practice on the preparation of undergraduate nurses to perform

invasive skills such as venous cannulation.

Conclusions: The goal of this comprehensive curriculum implementation is to meet a longstanding need

to ensure that novice nurses have the skills, knowledge and confidence to care for patients requiring

venous access. This curriculum responds to a call for better novice nurse training in vascular access and

infusion nursing.

Sonoist: An Innovative Medical Student-Developed Peer Teaching Initiative for

PoCUS Laura Ran Yan, Kacper Niburski, Linda Snell McGill University Background: Many studies have shown that the outcomes of peer-teaching of Point of Care Ultrasound

(PoCUS) is comparable to faculty teaching. However, no study has looked at it in a clinical context. As

simulated patients are used to teach technique, students lack the experience in clinical correlation of their

findings. This abstract describes the implementation and evaluation of an education innovation, Sonoist,

a student-run model for improving PoCUS training through bedside teaching.

Innovation: Sonoist is an ultrasound innovation developed by Independent-Practitioner certified medical

students teaching their peers how to scan inpatients with pathological findings. Six sessions were held

with an average of three participants and three patients scanned per session. Pre/post surveys collected

data on ultrasound knowledge and whether participants (beginners and experienced) believed they

improved.

Outcomes: Eighty-nine percent (17/19) completed the survey. Beginners experienced a self-reported

increase in perceived skill of 34% and 13.3 % in experienced learners (p<0.05). Both levels showed a 78%

gain in clinical indication of when to use ultrasound, and a similar increase in actual sonographic

knowledge (beginners 61%, experienced 57%, p<0.05). All levels said they would advocate for ultrasound

in the future. 88% of experienced users claimed that it was useful for clinical diagnosis. All beginners

preferred peer-to-peer teaching, whereas 78% (7/9) of experienced practitioners did.

Conclusion: Near-peer ultrasound teaching such as Sonoist improves students’ sonographic knowledge

and appropriate clinical application. Peer-to-peer teaching is preferred compared to staff-teaching in the

clinical context. Detecting positive ultrasound pathologies at the bedside increases students’ self-

perceived and measured improvement, as well as developing their skills in clinical diagnosis.

“Tisser les liens” Sharmin Jahin, Melanie Au, Alice Girard, Mohamed El Fares Djellatou, Francoise Filion

McGill University

Introduction: There is extensive research regarding negative impacts of peer intimidation among school-aged children, yet none focuses on Indigenous youth. The goal of this project was to start a conversation with the youth of a rural Atikamekw First Nation community about the challenges presented by intimidation and promote healthy child relationships and development. Methods: The frameworks embedded in the project were the Population Health Promotion model and the First Nations Holistic Lifelong Learning model. The creation of informative magnets and power-point presentations reached grade 5 and 6 elementary school students. The project also included Indigenous cultural art as team-building activities to foster unity and friendship. Results: Post activities, 40 students answered surveys where, 93.48 % were able to name all four types of intimidation, 72.65 % identified at least two strategies to combat bullying and 52.18 % were able to name four resources available to them. Conclusions: This project allowed open discussions on intimidation, developed interpersonal relationships and established mutual support for the elementary school youths. Sustainability of the project included a memory key with all the information presented and a toolkit for staff members of local schools. The long-term intention is to repeat the activities every year and evaluate its success on decreasing intimidation in primary school’s Atikamekw children. Our project brought awareness for intimidation and the professors

will have the opportunity to pursue our effort with all the material we provided. There is a scope for further research and implementation of anti-bullying conversation among all Indigenous communities.

Tumor Board Shadowing: A Unique Approach to integrating Radiation

Oncologists into General Medical Student Education James Man Git Tsui, Nicholas K.S. Grewal, Milani Sivapragasam, Melina Flanagan, Daniel Golden, Joanne

Alfieri, Malcolm Mattes

McGill University Health Centre

Introduction: Radiation oncology is often overlooked in medical school curricula, with few opportunities for most students to learn about the specialty or the value of radiation therapy in cancer care. Tumor boards represent a potential avenue not only to increase students' exposure to radiation oncologists but also to provide a fundamental understanding of the multidisciplinary nature of cancer care and effective collaboration in clinical practice. Methods: In this study, we evaluated a novel radiation oncologist-driven tumor board shadowing experience at 3 medical schools in the United States and Canada. A total of 323 first- and second-year medical students participated, of whom 77.4% completed a follow-up survey assessing the effectiveness of the program as a learning tool. Results: Compared with traditional clinical shadowing, students were more likely to believe that tumor board shadowing provided a similar or better experience in terms of educational content (85%), exposure to a new field (96%), and overall experience (89%). Forty-eight percent of students perceived a greater amount of multidisciplinary collaboration in oncologic care than they thought existed prior to attending. Forty-eight percent of students also felt more competent interacting with oncologists after participating, whereas 21% felt more competent interacting with patients with cancer. Conclusions: The multidisciplinary nature of cancer care in Radiation Oncology offers students an opportunity to witness firsthand during tumor boards discussion the practical application of the core competencies highlighted in the CanMEDS roles. Our study shows that the tumor board shadowing program can be used effectively as a unique immersive learning activity that can be feasibly implemented to improve knowledge of multidisciplinary care and clinical oncology in medical schools.

Creation of an Educational Quality Improvement Program for Radiation Oncology

Residents Joanne Alfieri, Catherine A. Pembroke, Alain Biron, Carolyn Freeman, Tarek Hijal

McGill University

Background: Quality improvement (QI) is at the centre of modern health care. When CanMEDS 2015

mandated that QI competencies be taught in all residency programs, a need was created. The objective is

to report on the feasibility and impact of a QI curriculum on McGill radiation oncology residents that was

created to address that need.

Innovation: A multidisciplinary QI team was created. A mandatory curriculum divided into foundation,

intermediate and advanced competencies was designed. Longitudinal QI curriculum consisted of: Phase

1 - 12 hours of lectures, practical workshops, and supplementary online modules; Phase 2 - 9-month QI

project; and a QI day enabling residents to present their work and compete for a prize. Program evaluation

used validated pre-post assessment tools. Answers were quantified using satisfaction indices (SI).

Outcomes: Assessments demonstrated improvements in residents’ QI knowledge following curriculum

implementation (n=10). Those who had completed a project had greater confidence with QI methodology

compared with those who had completed phase 1 alone (mean SI, 53% pre-curriculum to 66.5% and 90%).

The majority lacked previous QI teaching and knowledge, but learner attitudes improved (SI, 50% to 75%),

and 91% were enthusiastic about the program.

Conclusions: We have demonstrated that implementation of a QI curriculum is feasible and early results

suggest improvements in attitude and knowledge. We anticipate that the QI skills gained will enable

residents to elevate the quality of their practice throughout their subsequent careers. The current

academic year will examine the challenges of expanding this curriculum across 3 additional post-graduate

oncology programs.

EDUCATIONAL INNOVATION PART II: A FOCUS ON LEARNING METHODS & STRATEGIES

Faculty Club Gold Room 10:30 am – 12:00 pm

Innovative Online Learning Program: Fundamental Topics in Faculty

Development Tamara Carver, Audrey Juras

Background: The goals of this blended education program were to develop-reinforce-strengthen the

knowledge, skills and attitudes pertaining to the teaching roles of our faculty, enhance the teaching

capacity of our department, elevate the teaching related competency level of our faculty teachers, and

foster a community of practice.

There are four innovative aspects to the Faculty Development program for clinical teachers in Family

Medicine: (1) curriculum based on public standards for teachers and medical teachers from national and

international sources, (2) mandatory participation for all new hires in the last 5 years, (3) language of

instruction is available in French and English, (4) blended delivery modality for flexibility and timing of

learning.

Innovation: The program was delivered using a blended modality with asynchronous online lectures and

discussions, in-person local group discussions, and synchronous virtual face-to-face seminars using Zoom

video conferencing.

Outcomes: 116 participants completed the program: 58 of 66 mandatory participants passed the

program, and 46 of the 50 optional participants passed the program. 15 participants withdrew and 5

participants did not complete the program (maternity and personal leave).

Conclusions: This session is important to the field of health science education as it provides an innovative

way to design and deliver faculty development, emphasizes the importance of using technology in

education to adapt to the needs of learners and help develop a community of practice, and highlights the

fact that clinical teachers want to participate in online learning. In addition, the session will describe the

necessary support for developing and implementing a similar program.

Using an Online Case-Based Simulation with Delayed Feedback Can Facilitate

New Guidelines Adoption Sam J Daniel, Martin Tremblay, Patricia Wade, Beatriz Merlos

Continuing Professional Development Office, Federation of Medical Specialists of Quebec

Introduction: Uptake of self-learning complex clinical guidelines is low and busy healthcare professionals

easily overlook them. While digital education is increasingly used in continuing professional development,

it is unclear how effective it is in promoting guideline adoption. To address this gap, we decided to analyze

the effectiveness of a novel strategy for guideline adoption among specialist physicians using an algorithm

from a clinical practice guideline on the screening and follow-up of lung cancer. This guideline was

available in print and had very low uptake according to CPD leaders. We wanted participants to use a

clinical guideline algorithm to guide their practice and recognize gaps and consequences when a

systematic approach was not applied.

Methods: We developed a case-based, online module with 2 mandatory components. Part 1: Participants

are faced with options, consequences and alternative pathways associated with following or not the

algorithm. They must provide medical care using their clinical judgement. A delayed feedback is provided

on their performance. Part 2: they are guided through the same cases using the clinical guideline

algorithm, allowing them to compare their practice with the guidelines. A mandatory questionnaire was

used to assess perceived knowledge/attitude gain, plan learning opportunities, identify possible barriers

and how to overcome them, and declare intention to change strategies. The CPD REACTION questionnaire

was used to measure the impact on their learning.

Results: Self-reported intention to follow the algorithm in the 47 participants was high (76%) and

validated by REACT scores (mean of 6.2/7). The most prevalent indicators of change were the influence

of the social (mean of 5.9) and moral norms (mean of 6.2). Clinicians believed there were benefits to using

the algorithm for patients and the health system. Self-reported Efficacy beliefs increased by 44% but

REACT score indicated residual doubts (mean of 4.2/7) as to the ability to implement the pathways.

Participants identified several barriers and strategies to overcome them.

Conclusions: This project demonstrates that online case-based simulation with delayed feedback can

facilitate new guidelines adoption. Also CPD-REACTION tool can easily be incorporated to program

evaluations in order to measure healthcare professionals’ intention to change. Future research should

continue evaluating interactive, simulation-based digital education as a catalyst to guideline adoption and

report on patient outcomes.

Co-designed Game Learning for Cultural Safety in Colombian Medical Education:

A Pilot Randomized Controlled Trial Juan Pimentel, Anne Cockcroft, Neil Andersson

McGill University

Introduction: Cultural safety encourages practitioners to examine how their own culture shapes their

clinical practice and to respect their patients’ worldviews. Training in cultural safety is challenging. This

pilot randomized controlled trial explored the feasibility and acceptability of co-designed game learning

for cultural safety training in Colombia.

Methods: In 2017, we invited 79 senior medical students at La Sabana University (Chía, Colombia) to

participate in the study. The intervention group participated in a 5-hour workshop comprised of a one-

hour lecture on cultural safety and a four-hour hands-on session to create and play educational games,

including game dynamics, rewards, and penalties. The control group received a one-hour standard lesson

about cultural safety, followed by a four-hour study session derived from selected readings on cultural

safety. Online self-administered Likert-type questionnaires assessed self-reported cultural safety

behaviour before, immediately after, and four months after the intervention.

Results: 79 students completed the baseline questionnaire and were randomised. 64 participated; 31 in

the intervention group (20 female) and 33 in the control group (18 female). 35 completed the final

assessment (18 control and 17 intervention). Intervention students enjoyed the workshop and reported

a slightly higher cultural safety level after the intervention.

Conclusions: Co-designed game learning is feasible and acceptable for cultural safety training of

Colombian medical students. Our next step is to conduct a full-scale study with 300 medical students in

Colombia, with additional efforts to ensure retention of students throughout the study. The findings will

be relevant for education of health professionals in Colombia and elsewhere.

Developing Skills for Critical Appraisal of the Medical Literature: A Letter to the

Editor Workshop for Residents Annabel Chen-Tournoux, Bottega N, Whittaker HT, Skerritt L, Dankner M, Eisenberg MJ

Jewish General Hospital

Background: Traditional curricula aimed at teaching the CanMEDs Scholar role include didactic courses

and journal clubs, but, in such sessions, discussions remain local and resident engagement may be

variable. The McGill Adult Cardiology residency program sought to implement a letter to the editor writing

workshop to: 1) encourage resident contributions to scholarly discourse; 2) improve the ability to critique

scientific methods and reporting; and 3) provide opportunities for collaboration and feedback on writing

skills.

Innovation: A letter-writing workshop had previously been implemented for the McGill MD-PhD and

Clinician Investigator programs. Building on the success of this initiative, a similar workshop was piloted

for cardiology residents. Prior to the workshop, residents organized themselves into small groups,

selected a high-impact article, and reviewed submission instructions. During the 90-minute workshop,

groups drafted their letters, presented their work for comments, made revisions, and submitted the

letters. After 2 workshops over 2 years, 4 letters representing the work of 11 residents have been

published in high-impact journals (NEJM, JAMA and Circulation). These letters raised inquiries about

methods, additional analyses, pathophysiology to explain results, and directions for future study.

Outcomes: This pilot experience suggests that the letter writing workshop is an effective strategy to

engage residents in scientific discourse, help them hone critical appraisal and writing skills, and showcase

meaningful contributions to the wider scientific community.

Conclusions: Further research is needed to determine the best outcome measures to formally evaluate

the utility of such workshops in resident education.

Debunking Myths about Medical Errors Vimla Patel, Edward (Ted) H Shortliffe

The New York Academy of Medicine

Introduction: The major purpose of this research, which was started almost 3 decades ago under the aegis

of Dr. Richard Cruess, is to show that an expert clinician’s ability to manage error is far superior to the

abilities of residents or students, and this is achieved through a process of error detection (recognizing)

and recovery (correction), which plays a central role in the development of clinical expertise.

Methods: We conducted a series of studies at multiple sites to determine the relationship between

medical expertise and error management by doctors and medical students under various conditions: (a)

controlled laboratory experiments using simulated cases, (b) virtual 3D computer-based environments

using subject-controlled virtual avatars, (c) real clinical settings using simulated patient scenarios (a semi-

naturalistic approach) and, (d) the naturalistic setting during clinical rounds with real patients.

Results: Doctors (experts) detected and corrected their mistakes more frequently than did residents, who

did better than the senior medical students. They also performed better when working in teams and when

working in a real clinical practice setting. Furthermore, they were more able to monitor their own thought

processes (metacognitive skills), which is likely to have enhanced their error detection and correction

strategies.

Conclusions: Expertise does not relate to making fewer errors, but to recognizing and recovering quickly

from these errors. While the detection of error requires significant cognitive resources, subsequent

recovery is a complex process in which there is a reconstruction and reassessment of the original

erroneous action. These mechanisms are still poorly understood.

POSTER PRESENTATIONS Faculty Club Main Lounge

10:00 am – 10:30 am; 12:00 pm – 1:00 pm; 3:00 pm – 3:30 pm

Negative Self-Stereotyping as a Patient Partner Richard Hovey, Kristina Amja, Ms. Marie Vigouroux, Veeresh Mr. Pavate

McGill University

Introduction: The title of patient-partner is widely used when referring to a person living with a specific

health condition who participates in research or consults on clinical practice guidelines. Being a patient-

partner says nothing about one's potential role in a non-medical context. Labelling people as such can be

detrimental to their perception of themselves through negative self-stereotyping. The goal of this paper

is to bring awareness and confront the label of patient-partner outside the context of healthcare in order

to prevent negative stereotyping of one’s personhood.

Methods: We take a hermeneutic approach to explore how labelling and self-stereotyping can affect

the patient-partner, leading to the erosion of their personhood. This paper is based on lived experience

and observations from two Master students, one PhD student and their thesis supervisor in exploring the

meaning of being a patient outside of healthcare.

Outcomes: We suggest that research teams avoid the title patient-partner in favour of the more accurate

and dignified term patient perspective consultant. The shift from patient-partner to patient perspective

consultant doesn’t change the nature of the role, instead it clarifies the context through increased

accuracy.

Conclusions: The steps involved in materializing this change will help widen researchers’ and clinicians’

horizon of understanding of working with people from outside their discipline, and help foster a better

and safer environment for patient perspective consultants to make even more meaningful contributions

to their research teams through a stronger sense of belonging and legitimacy.

Competence by Design as Social Accountability: The Social Reproduction of the

Medical Profession Fernanda Claudio, Peter Nugus

McGill University

Introduction: This study examines the development of a new social contract between doctors and society

through the lens of Competence by Design (CBD) implementation in Canada. Three historical moments

have defined specialty training in medicine: the union of barber-surgeons and apothecaries in the early

19th century (Porter, 2002); the Flexner Report in 1910; and the trend toward competency-based

education in contemporary times. Each stage has entailed the construction of a specific medical

professional identity, and a concomitant social contract based on understandings of societal rights and

needs. Competence by Design (CBD), the Canadian version of competency-based medical education for

residency training, promises to create a new doctor who is scientifically informed and socially responsive.

However, with what effect? Throughout history, medical education has involved the production of specific

professional identities attuned to contemporary politics, philosophies and perceived societal needs.

Methods: We conducted a literature review of competency-based medical education approaches,

Competence-by-Design, and the sociological literature on social reproduction and education.

Results: CBD is a new form of the production of professional medical identities. It is marked as socially

responsive, promising to produce doctors who are both scientists and social actors, in other words, a new

professionalism. CBD sheds new light on the relationship between professionalism and social contract.

Examination of CBD through the vantage point of social reproduction theory (Bourdieu) provides tools to

understand the roles of both education and practice in the re-making of professional worlds. Education is

one key locus of social reproduction (Bourdieu, 1972; Freire, 1970). Yet this is mediated by structural

constraints in various forms (Collins, 2009), including, in this instance, contexts of practice.

Conclusions: Beyond the parameters of scientific medicine, CBD creates a medical professional identity

entangled with contemporary social and contextual factors, thus creating a new social contract.

A 1-Credit Genetics Course for Speech/Language Pathology Students Jennifer Fitzpatrick, Laurence Baret, Laura Russell, Laura Whelton and Kelly Root

McGill University

Background: Despite the explosion of genetic technologies and their enhanced applications to all health

sciences fields, little formal genetics education is occurring in health professional programs in Canada

other than medicine. The School of Communication Sciences and Disorders sought to integrate genetics

content into the Speech/Language Pathology Program’s curriculum and evaluate its effectiveness.

Innovation: Faculty in SCSD partnered with the Department of Human Genetics to develop the stand-

alone course, Genetics in the Practice of Speech/Language Pathology. Students first review basic

principles of human genetics online (Genetics Home Reference, https://ghr.nlm.nih.gov/primer). The

course is then held over 4 afternoons. Didactic presentations cover chromosome abnormalities, single

gene disorders, microdeletion syndromes and complex traits. Conditions relevant to SL/P practice (Down

syndrome, cleft lip/palate) are used as examples. Role plays develop skills in pedigree taking, assessing

the potential for an underlying genetic condition, addressing patient emotional responses to genetic

disorders and managing the ambiguity of the undiagnosed child.

Outcomes: Students evaluated the content as accessible, professionally relevant and leading to improved

comfort levels in addressing patient genetic concerns. In enhancing knowledge among SL/Ps of genetics

professionals’ roles, the course additionally meets learning goals of interprofessional education.

Conclusions: The course is a model for the successful integration of genetics content into new areas. Its

format can be readily adapted and exported to other health professional programs such as physical and

occupational therapy, nursing or physician assistants and is highly amenable to research assessing its

effectiveness using pre- and post-course questionnaires.

Exploring Child-Focused Professional Practices in Long Point First Nation and

Rapid Lake, Quebec Carly Heck, Satya Cobos, Franco Carnevale, Mary Ellen Macdonald

McGill University

Introduction: A recent international scoping review highlighted how ‘Indigenous Pedagogy’ is rarely included in curricular development for child-focused professional education programs. This gap in education risks the continuance of colonial practices in Canadian professional services, the devaluation of Indigenous knowledge, and worsening health outcomes for young Indigenous peoples. To explore how Indigenous Pedagogy can inform professional preparation, we consulted the Anishinabeg communities of Long Point First Nation and Rapid Lake, Quebec.

Methods: Qualitative descriptive methodology was used to elicit rich data from group and individual interviews with 10 young and 11 adult Anishinabeg leaders, and 15 child-focused professionals from multiple disciplines who work in these communities. We analyzed transcripts using inductive and deductive thematic analysis. Results: Consistent with the scoping review conclusions, our professional participants reported little to no exposure to Indigenous-specific content during their formal education. Anishinabeg participants saw importance in professionals learning Indigenous history and culture, partaking in cultural activities outside of formal professional interactions, having field-based education opportunities, and engaging youth with hands-on activities Our team’s future work will explore how these central messages are supported in consultations with other Indigenous leaders in Quebec. Conclusions: The findings we will present can be used to inform developments in education policy that contribute to reconciliation and promote the wellbeing of young Indigenous peoples. Child-focused professional practices that honour Indigenous ways of knowing are essential for the building of effective and culturally-safe relationships between professionals and Indigenous communities.

Nursing Student-Led Influenza Immunization Clinic for their Peers: A Novel

Opportunity for Health Promotion Hugo Marchand, Elizabeth Murphy-Lavalee, Stephanie Charbonneau, Elizabeth Leber, Amelie Samson,

Georgie Kamateros

McGill University

Background: Vaccination is part of the nursing scope of practice through reserved nursing activities in

Quebec. Clinical requirements often include receiving the influenza vaccine in order to protect their

patients and themselves. Opportunities for nursing students to administer influenza vaccines via intra-

muscular (IM) injection are scarce and often limited to community health settings. Given time constraints

experienced by students, easy access to vaccination is imperative to ensure uptake.

Innovation: Through partnership with the McGill University Wellness Hub, the Ingram School of Nursing

ran a seasonal influenza vaccination clinic where graduating nursing students were able to administer

immunization to their peers. This clinic was designed and implemented following the Protocole

d’Immunisation du Québec. Prior to administering vaccinations, students received a one-hour review

session facilitated by their trained peers in collaboration with a faculty member. Held over two days, 36

nursing students vaccinated over 180 students under the supervision of faculty members. Two exit

surveys were distributed, one to vaccinators and one to students receiving the influenza vaccine to

evaluate their experience.

Outcomes: Out of 28 respondents who administered a vaccine, only one had prior experience

administering IM injections; all felt more confident with their IM injection skills at the end of the clinical

experience. All respondents, giving and receiving vaccines, would recommend the experience to their

peers. The clinic has enabled positive bidirectional knowledge transfer between all groups of students,

which in return has impacted their level of confidence in providing safe IM injections.

Conclusions: This activity allowed learners to transition from a traditional passive role into an active role

by experiencing unique genuine cases. Active learning activities can be integrated in health science

education curricula to foster clinical reasoning.

Building Global Citizenship – Treading Global and Indigenous Health

Competencies throughout Graduate Nursing Curricula Irene Sarasua, Jodi Tuck, Francoise Filion, Catherine-Anne Miller, Maria DiFeo

McGill University

Background: With a broad understanding of health & well-being, nurses are ideally positioned to identify

the health impacts of public policies, but formal training to do so is often lacking. With ever-growing global

interconnectedness, nursing faculty are called upon to develop curricula that enable nurses to engage

more fully in influencing policy across boundaries and systems. To better address this gap, clarifying key

Global, Indigenous, Community, Public and Environmental Health Competencies needed in a

comprehensive nursing curriculum is a significant step to ensure we strategically develop a nursing

workforce able to mobilize communities towards health.

Innovation: In the context of the Master’s of Nursing curriculum at ISoN, a sub-committee reviewed the

literature to identify ‘global health’, ‘public and community health’ and ‘Indigenous health’ competency

frameworks targeted at health care professionals. Competencies within these chosen frameworks were

then incorporated into our existing ‘National Nursing Educational Framework’ (CASN 2015) to generate a

master Global and Indigenous health competency list.

Outcomes: The sub-committee identified challenges to harmonize each set of competencies with our

national nursing educational framework. An inclusive vision permitted to identify pertinent competencies

to ensure that students develop the necessary knowledge, skills and attitudes to practice safely and

humbly in global and Indigenous health.

Conclusions: The inclusion of Global, Community, Public, Indigenous and Environment health

competencies is vital to create a more ‘action-driven’ and ‘globally accountable’ healthcare workforce.

We foresee, as a future direction, threading all competencies mentioned above throughout all our nursing

programs.

Patients’ and Families’ Unsolicited Correspondence to Doctors: An Innovative

Way to promote Professional Identity Formation Mark J Yaffe, Richard B. Hovey, Charo Rodríguez

McGill University

Background: Problem requiring addressing: Medical students and residents sometimes perceive teaching

about positive professional identity as theoretical or “text-book” generated.

Innovation: Using the notion of ‘patient as educator’ we examined 107 unsolicited writings sent over four

decades by patients to one family physician. Univariate analyses identified features of patients / family

members who wrote, and in what fashion. A hermeneutic approach helped analyze note content, words

or sentiments used to describe encounters. Iterative review of words or phrases generated themes

summarizing appreciated physician or relational attributes.

Outcomes: Appreciated doctor characteristics and behaviors were quality continuous care, competence,

physical presence, positive personal traits, emotional support, and spiritual impact. Motivations for

writing were expression of appreciation for an established, continuous relationship; seeking catharsis,

emotional relief or closure; reflection on termination of care; validation of care that incorporated both

Hippocratic and Asklepian traditions; and sharing of personal reflection, experience, or impact.

Conclusions: Unsolicited writings provide personalized links from patients to physicians, expressing

thoughts perhaps difficult to share face to face. They not only inform doctors at the time of receipt, but

when examined as a collection may provide feedback about how ones care is perceived over time. It may

validate and promote existing practices, or may be stimulus for reflection and self-improvement. Such

“real life” testimonies, if incorporated into the teaching setting, may provide learners with credible

examples and models of what patients value in their doctors.

Strengthening Health Equity in Education and Practice: Narratives of Indigenous

Experiences in Health Care as a Teaching Tool Lloy Wylie

Western University

Background: Medical schools are facing the challenge of addressing Reconciliation with Indigenous people

through advancing the TRC calls to action in relation to health professional education. Our research has

demonstrated a range of gaps in addressing the health care needs of Indigenous populations that are

based on knowledge gaps regarding Indigenous specific determinants of health (Wylie and McConkey

2019, Wylie et al 2019).

Innovation: Although new training initiatives are starting to address these gaps, First Nations people have

raised the need to have training that is locally specific, based on community knowledge and experiences.

Drawing on a qualitative research study on access to health care services, the presentation will illustrate

a range of challenges facing Indigenous people, both within the health care system and more broadly

embedded within social determinants of health.

Outcomes: Many initiatives to advance equity have focused on the front line care

providers’ competencies in cross cultural practice. This poster will demonstrate ways to

build competencies among medical students, residents and physicians to advance health equity, that go

beyond cultural competence, instead focusing on reflexive practice that aims at understanding health

system gaps identified by First Nations. Narratives drawing on examples from health care experiences will

be used to illustrate the challenges of where the health care system is failing to meet the needs of

Indigenous people. This poster aims to present strategies to address this gap in health care that

undermines quality and equity, through advancing knowledge and training based on First Nations’

community recommendations.

Conclusions: Despite the importance of the competencies of front line care providers, our research has

demonstrated that targeted educational initiatives often fall short of moving from the knowledge realm

to practice. In this poster, I argue that this gap is due to the limitations of focusing on individual rather

than system level issues in advancing transformative change. Understanding the ways that our health

systems perpetuate inequity through policy and organizational culture through sharing community

narratives can help identify processes of improving front line care for Indigenous people.