bluuebunny/crossref_metadata_2025 huggingface dataset:
27. Immigration and other evils: A profile of Dr. C. K. Clarke and the eugenics movement in Canada
Authors: Lee L.
Published: May 2017

Dr. C.K. Clarke (1857-1924) was one of Canada’s most prominent psychiatrists. He sought to improve the conditions of asylums, helped to legitimize psychiatry and established formal training for nurses.

At the beginning of the 20th Century, Canada experienced a surge of immigration. Yet – as many historians have shown – a widespread anti-foreigner sentiment within the public remained. Along with many other members of the fledgling eugenics movement, Clarke believed that the proportion of “mental defectives” was higher in the immigrant population than in the Canadian population and campaigned to restrict immigration. He appealed to the government to track immigrants and deport them once they showed signs of mental illness. Clarke’s efforts lead to amendments to the Immigration Act in 1919, which authorized deportation of people who were not Canadian-born, regardless of how many years that had been in Canada. This change applied not only to the mentally ill but also to those who could no longer work due to injury and to those who did not follow social norms.

Clarke is a fascinating example of how we judge historical figures. He lived in a time where what we now think of as xenophobia was a socially acceptable, even worthy attitude. As a leader in eugenics, therefore, he was a progressive. Other biographers have recognized Clarke’s racist opinions, some of whom justify them as keeping with the social values of his era. In further exploring Clarke’s interest in these issues, this paper relies on his personal scrapbooks held in the CAMH archives. These documents contain personal papers, poems and stories that proclaim his anti-Semitic and anti-foreigner views. Whether we allow his involvement in the eugenics movement to overshadow his accomplishments or ignore his racist leanings to celebrate his memory is the subject of ongoing debate.

Dowbiggin IR. Keeping America Sane: Psychiatry and Eugenics in the United States and Canada 1880-1940. Ithaca and London: Cornell University Press, 1997.

McLaren A. Our Own Master Race: Eugenics in Canada 1885-1945. Toronto: McClelland and Stewart, 1990.

Roberts B. Whence They Came: Deportation from Canada 1900-1935. Ottawa: University of Ottawa Press, 1988.
33. How to steal a body
Authors: Turner C.
Published: May 2017

You are a medical student in 1820, training in anatomy has now become a prerequisite to graduation but there are limited cadavers available for dissection. Could you be a body snatcher? What about if you only took unclaimed bodies? What if you didn’t actually excavate, just helped drive the wagon? What would be your conditions before you would turn to a life of crime? Keep in mind that just by “borrowing” the occasional body you would provide yourself with ample opportunities to learn anatomy and also easily afford your tuition.

If you do decide to go ahead and become a body snatcher you’re going to have to learn the classic modus operandi employed by the best in the business.

First of all you want to do some daytime reconnaissance by attending the burial to see if any booby traps are being set for potential body snatchers. Next, you return at night with a wagon and drop two men off at the burial site. They then start digging a 3’X3’ hole until they hit the coffin. The body is carefully extracted and any identifying clothing or jewelry is removed and put back in the coffin before being reburied.

Now you might be worried about retribution but you really don’t have much to fear. Townsfolk have been known to protest in front of medical schools but you’d have to deal with this even if you weren’t a body snatcher. If you end up going to court the worst that would happen is a fine that you could easily pay off by stealing another body or two.

Highet MJ. 2005. Body snatching and grave robbing: bodies for science. History and Anthropology 2005; 16(4):415-440.

MacGillivray R. Body snatching in Ontario. CBMH/BCHM 1988; 5:51-60.

Ross I, Ross CU. Body snatching in 19th Century Britain: from exhumation to murder. British Journal of Law and Society 1979; 6(1):108-118.
34. A brief history of cardiac arrhythmia
Authors: Ducas R.
Published: May 2017

Throughout the ages there has been little else as impressive to both the patient and physician as abnormalities and aberrancy in the heartbeat. It was through careful observation and characterization of physiology that the tactile measurement of the pulse translated and evolved in to the vast field of cardiology we know today. For thousands of years the only window physicians had into the hearts of their patients was through palpation of a pulse. The ancient Egyptians, Chinese and Greeks are credited with measurement and characterization of peripheral pulses and their association with illness. The work of Claudius Galen (129-199) furthered the association of pulse to cardiac function. Galen’s work set the stage for William Harvey’s (1578-1657) first description of the circulatory system and thereafter the function of the heart. However, it was not until the advent of electrocardiography that modern, efficient studies of cardiac rhythm began. The work of August Desir Waller (1856-1922) and Willem Einthoven (1860-1927) revolutionized the study of arrhythmia with the advent of the electrocardiogram (ECG). This instrument transformed the diagnosis of heart disease and catalyzed the creation of cardiology as a subspecialty. It was through the use of the ECG that cardiac rhythm disorders were first characterized. James Mackenzie and Arthur Cushny first recognized atrial fibrillation and the work of Drs. Wolf, Parkinson and White theorized the neuro-cardiac function of the heart. Further study led to the discovery of the Purkinje system and the mechanics of cardiac electrical conduction. Medicine has thus used many approaches in the treatment of arrhythmias, employing pharmacology, electricity and surgery, with an ever-evolving spectrum of treatment. It was through observation, innovation and determination that diseases of the heart are understood and treated today.

Hanon S, Shapiro M, Schweitzer P. A troubled beginning: Evolving concepts of an old arrhythmia. J. Electrocardiol. 2005 (July); 38(3):213-7.

Fye,W. Tracing atrial fibrillation - 100 years. N Engl J Med. 2006 (Oct); 5;355(14):1412-4.

Lüderitz B. History of the disorders of cardiac rhythm. 3rd Ed. Armonk, NY: Futura Pub. Co., 2002.
35. Models that change: The study of gay identity development
Authors: Heng K.
Published: May 2017

Since the declassification of homosexuality as a mental disorder by the American Psychiatric Association in 1974, a large number of models of gay identity development have been proposed in the literature. This is unique because for the first time, more attention was paid to the process of developing a gay identity rather than theorizing about the etiologies of homosexuality. This paper reviews the changes in thought found in the literature describing how one comes to develop a gay identity.

For the marginalized, identity development is generally described against a backdrop of stigma. Fortunately, our current society is very different from the hostile world that surrounded the APA in 1974: homosexuality is more tolerated and accepted, laws are less discriminatory, and gay role models are more abundant and accessible. As society has evolved, so too have its descriptive models. Shame and reluctance are found in Plumer’s (1975) and Lee’s (1977) models. Pride and activism appear in Hencken and O’Dowd’s (1977) and Cass’ (1979) models. Troiden (1989) mentions the fear of AIDS in his writings. Alderson’s (1998) model reflects a climate where religion, friends, and society can be catalysts in developing a positive identity. Taken together, these models are like time capsules containing clues as to the social conditions of the time.

As the rate of social evolution accelerates, it is doubtful that any model regarding marginalized individuals will ever become definitive. For the case of homosexuality, if and when its stigma is removed, then the defining feature of gay identity development is also removed. It is possible that in its place will be a general model of sexual identity development, where homosexual and heterosexual paths diverge innocently and quietly in a society that does not value one over the other.

Alderson K. The ecological model of gay male identity. The Canadian Journal of Human Sexuality 2003; 12(2):75-85.

Cass V. Homosexual identity formation: A theoretical model. Journal of Homosexuality 1979; 4(3):219-35.

Troiden R. The formation of homosexual identities. Journal of Homosexuality 1989; 17(1/2):43-73.
40. The evolution of prosthetics
Authors: Kam A.
Published: May 2017

Throughout history, prosthetic limbs have undergone significant changes in design and function. For example, an ancient bronze and iron prosthesis with a wooden core, discovered in Italy and dated back to 300 BC, has evolved into a modern shock-absorbing multi-axis prosthetic foot for walking on uneven ground. Recent advances in “neuro-controlled” prosthetics with microprocessor controllers further allow their users to produce smooth, multi-joint movements, simulating “real limbs”. With an increase in government funding focusing on researches in independent mobility, it is expected that new designs will improve immensely the quality of life of amputees. Are we approaching closer to the “ideal prosthetic limb”? The objective of this paper is to examine the evolution of various prosthetic designs and to re-apply some of the old concepts into new designs. The method used is mainly literature review. Results/conclusion: N/A.

Wetz H, Gisbertz D. History of artificial limbs for the leg. Orthopade 2000; 29(12):1018-32.

Pascual G. Amputations, walking and prosthesis development. An R Acad Nac Med (Madr) 2003; 120(3):593-607.

Cottrell-Ikerd V, Ikerd F, Jenkins DW. The Syme’s amputation: a correlation of surgical technique and prosthetic management with an historical perspective 1994; 33(4):355-64.
43. "Consider whether I show a man's wisdom": The enigmatic Dr. James Barry
Authors: Afolabi T.
Published: May 2017

No matter how thorough and diligent the approach to compiling a historical record, occasionally crucial and interesting figures are overlooked. Such is the case with Dr. James Barry.

A nineteenth Century British doctor, Barry was named inspector general of military hospitals and traveled extensively throughout the British Empire. Barry’s story merits telling for both professional and personal reasons. Firstly, in the 1820s, Barry performed what is understood to be the first Cesarean section in which both mother and child survived. However, this notable accomplishment remains absent from many accounts of the history of the cesarean section.

Far more astonishing, however, is that Barry expertly performed his role as a military doctor while somehow concealing his sex, for upon his death he was discovered to not be male.

This paper will examine how a member of the British army was able to conceal such a crucial fact during a career that spanned nearly 50 years. By revisiting army letters, nineteenth Century reports and recent developments, it will be argued that our oversight of Barry’s story is due largely to two main reasons. Firstly, Barry possessed intelligence and skill that gained him the respect of colleagues and superiors alike, and allowed him to quickly rise up military ranks. This respect and high rank no doubt shielded him scrutiny and questioning. Secondly, Barry’s secret was further concealed by a diplomatic and tactful doctor who, after performing a post-mortem, attempted to save face for a doctor he no doubt respected immensely. The circumstances surrounding this attempted concealment as well as the ensuing controversy are examined in this discussion of an elusive and enigmatic doctor.

Rae I. The strange story of Dr. James Barry. London: Longmans, 1958.

Kirby P. Dr. James Barry, Controversial South African Medical Figure: A recent evaluation of his life and sex. S.A. Med. J 1970; 506-516.

Kubba A, Young M. The Life, Work and Gender of Dr. James Barry MD (1795-1865). Proc. R Col. Phys. Eding. 2001; 31:352-356.
46. Did the CME/CPD train leave with half the passengers? A needs assessment of Québec specialist associations' CPD units
Authors: Hudon G. , Laprise R. , Guindon L.
Published: May 2017

This presentation reports on the results of a needs assessment conducted amongst the 34 Quebec specialist associations, which are accredited as CME/CPD providers by Quebec’s College of Physicians, in accordance with the Canadian Association of Continuing Medical Education’s criteria.

In 2006, a mix of methods (survey, semi-structured interviews and program documentation review) were used to assess CPD units’ learning needs in the areas of CME and CPD, the extent to which they carried out a list of specific tasks associated to providers’ responsibilities, barriers encountered in meeting standards, and the kind of help needed to improve performance.

Although CME/CPD fields have evolved considerably in the past 20 years, results indicate that few of the advances have made their way down to the associations. The majority still provides education in the form of traditional CME, where speakers talk about new developments in medicine. Whereas the systematic approach of CME is well integrated in most units, few go beyond perceptions in their needs assessments, use problem-based learning methods, enablers, reinforcement and outcome evaluations, or help specialists self-evaluate and reflect on their practice. These methods and approaches are believed to increase CME effectiveness.

Most Canadian specialists get a large proportion of their CE from non academic medical organizations such as professional associations and learned societies. However, information available in the literature does not allow generalization of our observations to other organizations of this nature. Since non academic organizations are important CME/CPD providers, we propose that more attention be given on the way trainers are trained and innovations are shared in our CE system. What minimal knowledge and skills should be required of a CME/CPD professional today? Together with its affiliated associations and academic partners, the Federation of Medical Specialists of Quebec (FMSQ) has decided to tackle this important issue in the coming years.

Olson CA, Tooman TR, Leist JC. Contents of a core library in continuing medical education: a delphi study. JCEHP 2005; 25:278-88.

Davis DA, Thomson MA, Oxman AD, Haynes RB. Changing physician performance: a systematic review of the effect of continuing medical education strategies. JAMA 1995; 274:700-5.

Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients' care. Lancet 2003; 362:1225-30.
50. Health advocacy in surgical training: A Canadian survey on attitudes and experience in urology residency
Authors: Siemens D. R. , Leveridge M. , Beiko D. , Wilson J. W.L.
Published: May 2017

We sought to assess surgical residents’ perceptions and attitudes toward health advocacy in residency training and practice by administering an anonymous, cross-sectional, self-report questionnaire to all final year urology residents in Canadian training programs.

The survey was closed-ended and employed a 5-point Likert scale designed to assess familiarity with the concept of health advocacy and its application and importance to training and practice. Descriptive and correlative statistics were used to analyze the responses.

There was a 93% response rate from the chief residents. Most residents were well aware of the role of health advocate in urology, and a majority (68%) believe it to be important in residency training and in the urologist’s role in practice. However, a minority (7-25%) agreed that formal training or mentorship in health advocacy was available at their institution, and only 21-39% felt that they had employed its principles in the clinic or community. Only 4-7% or residents surveyed were aware of or had participated in local urologic health advocacy groups.

Despite knowledge and acceptance of the importance of the health advocate role, there is a perceived lack of formal training and a dearth of participation during urologic residency training.

Verma S, Flynn L, Seguin R. Faculty’s and Residents’ Perceptions of Teaching and Evaluating the Role of Health Advocate. Acad Med. 2005; 80:103–108.

Oandasen I. Health advocacy: bringing clarity to educators through the voices of physician health advocates. Acad Med. 2005 (Oct); 80(10 Suppl):S38-41.

Frank JR. (Ed). The CanMEDS 2005 physician competency framework. Better standards. Better physicians. Better care. Ottawa: The Royal College of Physicians and Surgeons of Canada, 2005.
54. Assessing cardiac physical examination competence using simulation technology and real patientss
Authors: Cole G. , Hatala R. , Issenberg S. B. , Kassen B. , Bacchus C. M. , Scalese R. J.
Published: May 2017

Assessment of residents’ physical examination skills often involves the use of standardized patients lacking physical abnormalities. Simulation technology offers the potential benefit of mimicking physical abnormalities. The current study was undertaken to examine the relationship between physicians’ competence in cardiac physical examination as assessed using simulation technology compared to real patients.

An OSCE was created using 3 modalities of cardiac patients: real patients (RP) with cardiac abnormalities, standardized patients (SP) combined with a computer-based audio-video simulation of auscultatory abnormalities and a cardiopulmonary patient simulator (CPS). The same four cardiac diagnoses were tested with each modality.

Participants were 28 internists, within 3 years of passing the Royal College of Physicians and Surgeons of Canada’s (RCPSC) Comprehensive Examination in Internal Medicine. At each station, two RCPSC examiners independently rated a participant’s physical examination technique and provided a global rating of clinical competence. The accuracy of a participant’s cardiac diagnosis for each patient was scored separately by two investigators.

The inter-rater reliability between examiners, for the global rating outcome, was 0.76 for RP stations, 0.78 for SP stations and 0.75 for CPS stations. The correlations between participants’ global ratings on each modality were: RP vs. SP, r=0.19; RP vs. CPS, r=0.22; SP vs. CPS, r=0.57 (p < 0.01).

A number of methodological limitations were highlighted during the study, including difficulties in truly matching patients within and between modalities, differential weighting of components into the examiners’ global ratings based on modality and limitations of case specificity. No modality provided a clear “gold standard” to assess residents’ cardiac physical examination competence. In the context of assessment, until these limitations are addressed, simulation modalities may not be directly interchangeable with real patients.

Boulet JR, Swanson DB. Psychometric challenges of using simulations for high-stakes assessment. In: Dunn WF (ed). Simulators in critical care education and beyond. Des Plaines, IL: Society of Critical Care Medicine 2004; 119-30.

Hatala R, Kassen BO, Nishikawa J, Cole G, Issenberg SB. Incorporating simulation technology in a Canadian national specialty examination: a descriptive report. Academic Medicine. 2005; 80(6):554-6.

Issenberg SB, McGaghie WC, Petrusa ER, Gordon DL, Scalese RJ. Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Med Teach. 2005; 27(1):10-28.
59. General medicine residents' perception of the mini-CEXs
Authors: Malhotra S. , Hatala R. , Courneya C.-A.
Published: May 2017

The mini-CEX is a 30 minute observed clinical encounter. It can be done in the outpatient, inpatient or emergency room setting. It strives to look at several parameters including a clinical history, physical, professionalism and overall clinical competence. Trainees are rated using a 9-point scoring system: 1-3 unsatisfactory, 4-6 satisfactory and 7-9 superior.

Eight months after the introduction of the mini-CEX to the core University of British Columbia Internal Medicine Residents, a one hour semi-structured focus group for residents in each of the three years took place. The focus groups were conducted by an independent moderator, audio-recorded and transcribed.

Using a phenomenological approach the comments made by the focus groups participants were read independently by three authors, organized into major themes. In doing so, several intriguing common patterns were revealed on how General Medicine Residents perceive their experience in completing a mini-CEX.

The themes include Education, Assessment and Preparation for the Royal College of Physicians and Surgeons Internal Medicine exam. Resident learners perceived that the mini-CEX process provided insight into their clinical strengths and weaknesses. Focus group participants favored that the mini-CEX experience will benefit them in preparation, and successful completion of their licensing exam.

Daelmans HE, Overmeer RM, van der Hem-Stockroos HH, Scherpbier AJ, Stehouwer CD, van der Vleuten CP. In-training assessment: qualitative study of effects on supervision and feedback in an undergraduate clinical rotation. Medical Education 2006; 40(1):51-8.

De Lima AA, Henquin R, Thierer J, Paulin J, Lamari S, Belcastro F, Van der Vleuten CPM. A qualitative study of the impact on learning of the mini clinical evaluation exercise in postgraduate training. Medical Teacher January 2005; 27(1):46-52.

DiCicco-Bloom B, Crabtree BF. The Qualitative Research Interview. Medical Education 2006; 40:314-32.
60. Using a pocket card to improve end-of-life care on clinical teaching units: A controlled trials
Authors: Downar J. , Mikhael J.
Published: May 2017

Although palliative and end-of-life is a critical part of in-hospital medical care, residents often have very little formal education in this field. To determine the efficacy of a symptom management pocket card in improving the comfort level and knowledge of residents in delivering end-of-life care on medical clinical teaching units, we performed a controlled trial involving residents on three clinical teaching units.

Residents at each site were given a 5-minute questionnaire at the start and at the end of their medicine ward rotation. Measures of self-reported comfort levels were assessed, as were 5 multiple-choice questions reflecting key knowledge areas in end-of-life care. Residents at all three sites were given didactic teaching sessions covering key concepts in palliative and end-of-life care over the course of their medicine ward rotation. Residents at the intervention site were also given a pocket card with information regarding symptom management in end-of-life care.

Over 10 months, 137 residents participated on the three clinical teaching units. Comfort levels improved in both control (p < 0.01) and intervention groups (p < 0.01), but the intervention group was significantly more comfortable than the control group at the end of their rotations (z=2.77, p < 0.01). Knowledge was not significantly improved in the control group (p=0.07), but was significantly improved in the intervention group (p < 0.01). The knowledge difference between the two groups approached but did not reach statistical significance at the end of their rotation.

In conclusion, our pocket card is a feasible, economical educational intervention that improves resident comfort level and knowledge in delivering end-of-life care on clinical teaching units.

Oneschuk D, Moloughney B, Jones-McLean E, Challis A. The Status of Undergraduate Palliative Medicine Education in Canada: a 2001 Survey. Journal Palliative Care 2004; 20:32.

Tiernan E, Kearney M, Lynch AM, Holland N, Pyne P. Effectiveness of a teaching programme in pain and symptom management for junior house officers. Support Care Cancer 2001; 9:606-610.

Okon TR, Evans JM, Gomez CF, Blackhall LJ. Palliative Educational Outcome with Implementation of PEACE Tool Integrated Clinical Pathway. Journal of Palliative Medicine 2004; 7:279-295.
61. Primary ophthalmic care patterns and training of University of Ottawa residentss
Authors: Sogbesan E. A. , Fournier A. , Damji K.
Published: May 2017

This study assessed whether residents are equipped to perform recommended standards of ophthalmic primary care and determined if the findings reflect the adequacy of their undergraduate and postgraduate teaching in ophthalmology. Information was collected using web based online questionnaire that was completed by residents in the residency program at the University of Ottawa. Data was extracted and analyzed using Epi Info software.

One hundred and sixteen residents (17% capture rate) in all years of training completed the online questionnaire. Majority of the residents were not familiar with the different vision screening guidelines, less so with the Canadian (63 – 97%) than the American guidelines (91 – 94%). This was reflected in their referral patterns and mixed results of ophthalmic knowledge assessments. Only 21% of respondents were highly confident or confident in dealing with patients with eye problems. However, most were confident in history taking, visual acuity assessment and examination, but less so with ophthalmoscopy and intraocular pressure measurements.

The duration of undergraduate ophthalmic clerkship was at least one week in most of the institutions. However, about one third of the residents surveyed did not have any ophthalmology clerkship in medical school. Only 33% felt that their clerkship was adequate and about the same proportion felt that they received adequate ophthalmic exposure of relevance to their current practice. About 90% of the residents have not attended an update course in ophthalmology. Over 75% of the residents thought that a continuing education program in Ophthalmology would be useful and would be interested in attending such a program in the future.

Opportunities exist to address these inadequacies to better prepare residents for clinical practice. These include improvements in undergraduate ophthalmic education, inclusion of ophthalmology electives in residency training programs and the development of a continuing education program in ophthalmology for primary eye care physicians.

US Preventive Services Task Force: Screening for visual impairment in Children younger than five years: recommendation statement. American Family Physician 2005; 71(2): 333-340.

Feightner JW. Routine preschool screening for visual and hearing problems. In: Canadian Task Force on the Periodic Health Examination. Canadian guide to clinical preventive health care. Ottawa: Health Canada, 1994:298-304.

Bellan L. Ophthalmology undergraduate education in Canada. Can J Ophthalmol. 1998; 33(1):3 – 7.
63. Developing a program for resident wellness at the postgraduate medical education office, University of Torontos
Authors: Edwards S. , Verma S. , Zulla R.
Published: May 2017

Prevalence of stress-related mental health problems in residents is equal to, or greater than, the general population. Medical training has been identified as the most significant negative influence on resident mental health. At the same time, residents possess inadequate stress management and general wellness skills and poor help-seeking behaviours. Unique barriers prevent residents from self-identifying and seeking assistance. Stress management programs in medical education have been shown to decrease subjective distress and increase wellness and coping skills.

The University of Toronto operates the largest postgraduate medical training program in the country. The Director of Resident Wellness position was created in the Postgraduate Medical Education Office to develop a systemic approach to resident wellness that facilitates early detection and intervention of significant stress related problems and promote professionalism.

Phase One of this new initiative has been to highlight its presence to residents and program directors by speaking to resident wellness issues at educational events. Resources on stress management, professional services, mental health, and financial management have been identified and posted on the postgraduate medical education website and circulated to program directors. Partnerships have been established with physician health professionals, the University of Toronto, and the Professional Association of Residents and Internes of Ontario. Research opportunities for determining prevalence and effective management strategies for stress related problems are being identified and ultimately programs/resources will be implemented to ensure that resident have readily accessible resources.

The establishment of a Resident Wellness Strategy from its embryonic stags and the challenges faced are presented as a template for implementing similar programs at other medical schools.

Earle L, Kelly L. Coping Strategies, Depression and Anxiety among Ontario Family Medicine Residents. Canadian Family Physician 2005; 51:242-3.

Cohen J, Patten S. Well-being in residency training: a survey examining resident physician satisfaction both within and outside of residency training and mental health in Alberta. BMC Medical Education; 5(21).

Levey RE. Sources of stress for residents and recommendations for programs to assist them. Academic Med 2001; 70(2):142-150.
65. Concurrent pursuit of degrees and courses during community medicine residency: Challenges, policies and proceduress
Authors: Russell M. L. , Vollman A. Robinson , Strudsholm T.
Published: May 2017

We describe the policies and practices of Canadian Community Medicine (CM) residency programs regarding the Royal College requirement for one year of academic course work.

We surveyed 10 Program Directors (PD) of the 11 Canadian CM residency programs (excluding our university) by either telephone interview or written completion of a structured interview guide. Questions addressed: what is currently allowed and/or encouraged; the policies in place; and the benefits and challenges to concurrent pursuit of degrees by CM residents. Of particular interest were policies regarding residents studying off-site and what actions PDs take if courses or degrees desired by a resident were not available at the home university.

Seven of 10 PDs replied. Most programs did not have written policies to deal with requests to study off-site; decisions were made on a case-by-case basis. When approved, residents received salary support and bore all costs of off-site education. Several CM programs require degree acquisition during the academic year; others encourage degree acquisition. While CM program websites indicate degree completion is possible within one calendar year, often practicum placements run concurrently with resident clinical rotations or projects are competed during residency rotations. Most programs prefer residents to stay on campus for their contribution to rounds and on-call, socialization of the cohort, and continuity.

It would be helpful to programs generally if PDs had policies to guide decisions; it would be particularly useful for the specialty if this were (to the degree possible) a common policy across universities. PDs and universities wish to make academic learning more readily accessible. We suggest a focus on the development of quality distance learning and innovative strategies to share course development and improve residents’ access to learning without the need to go off-site.

Zweifler J, Evans R. Development of a residency/MPH Program. Fam Med 2001; 33(6):453-8.

Tilak GS, Baker SR. Self-subsidization of educational expenses by senior radiology residents. Acad Radiol 2007; 14:105-9.

Walter DA, Rosenquist PB, Bawtinhimer G. Distance learning technologies in the training of psychiatry residents; a critical assessment. Acad Psychiatry 2004; 28(10):60-5.
69. International medical graduates (IMGs) needs assessment study: A comparison between current IMG trainees and program directorss
Authors: Verma S. , Zulla R. , Baerlocher M. O.
Published: May 2017

A needs assessment study was conducted to explore the types of issues or challenges IMG trainees encounter and the experiences of Program Directors with teaching this unique group. Both groups were asked to rate the importance of a series of issues in a horizontal curriculum using a 5-point Likert Scale. These issues fell under one of the following categories: Clinical Skills and Knowledge, Other Skills, Communication and Working Relationships, Macro Issues and Other Work-Related Issues. The scale was then collapsed to a 3-point Likert scale. Results were used to develop a horizontal curriculum for incoming IMGs to help ease their transition into residency training within the Canadian context.

The majority of program directors (93%) and IMG trainees (63%) surveyed agreed that a horizontal curriculum for IMGs should be developed. Program Directors indicated that basic clinical skills and communication with team members were important to include (79% and 90%, respectively). IMGs felt that Marco Issues were importance in a horizontal curriculum, namely an orientation about the Canadian healthcare system and site hospitals (71% and 59%, respectively), followed by communication with patients (67%). Significant differences were found with regards to the inclusion of communication with other residents and the inclusion of orientation sessions on the Canadian Health Care System and site hospitals.

These findings demonstrate there is a need for a core IMG curriculum. There is a slight disparity regarding what specific topics to include but a consensus between both groups exists on the primary domains of communication, inclusion of specialty specific skills and knowledge as well as professional interaction.

Kraemer M. Educational Challenges of International Medical Graduates in Psychiatric Residents. Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry 2006; 34(1):163-171.

Whelan GP. Coming to American: The integration of the International Medical Graduates into the American Medical Culture. Academic Medicine 2005; 81(2):176-178.

Majumdar, B, Keystone JS, Cuttress LA. Cultural Sensitivity Training among Foreign Medical Graduates. Medical Education 1999; 33:177-184.
70. Supporting IMG integration into residency trainings
Authors: Takahashi S. Glover , Alameddine M. , Martin D. , Verma S. , Edwards S.
Published: May 2017

This paper is describes the design, development, implementation and evaluation of a preparatory training program for international medical trainees. The program was offered for one week full time shortly before they begin their residency training programs. First the paper reports on the survey and focus groups that guided the learning objectives and the course content. Next the paper describes the curriculum development phase and reports on the topical themes, session goals and objectives and learning materials. Three main themes emerged when developing the program: understanding the educational, health and practice systems in Canada; development of communication skills; and supporting personal success in residency training including self assessment, reflection and personal wellness. Sample lesson plans and handouts from each of the theme areas are illustrated. The comprehensive evaluation of the sessions and the overall program is then also described. The paper then summarizes the identified key issues and challenges in the design and implementation of a preparatory training program for international medical trainees before they begin their residency training programs.

Allan GM, Manca D, Szafran O, Korownyk C. Workforce issues in general surgery. Am Surg. 2007 Feb; 73(2):100-8.

Dauphinee, WD. The circle game: understanding physician migration patterns within Canada. Acad Med. 2006 (Dec); 81(12 Suppl):S49-54.

Spike NA. International medical graduates: the Australian perspective. Academic Medicine. 2006 (Sept); 81(9):842-6.
71. Are video interviews a good alternative to in person interviews in assessing international applicants' skills?
Authors: Alameddine M. , Imrie K. , Akers S. , Verma S.
Published: May 2017

We developed and administered two questionnaires to assess the interview experience of both interviewers and applicants during postgraduate medical selection interviews. Using a 5 point likert scale, the questionnaires assessed three areas (1) ability to show/assess communication, interpersonal and problem solving skills; (2) ability to know the other side well and (3) level of comfort with the interview. Interviewers and applicants were asked to provide a global rating for the interview. The questionnaires were administered to both candidates and applicants from 6 departments in 18 in-person and 12 video interviews. 30 applicant and 87 interviewer survey forms were collected and analyzed. T-tests were used to compare the means of the two groups and significance levels were analyzed. Both interviewers and applicants had a higher average global satisfaction for video interviews compared to in person interviews. No difference was indicated in the ability of interviewers to assess the applicants’ skills between the two types of interviews. For both interviewers and applicants, video interviews, compared to in person interview, had a lower average score for connecting personally & establishing rapport and for satisfaction with administrative arrangements. Video interviewed applicants had a 50% probability of getting accepted in a program compared to 22% of in person interviewed candidates. We conclude that video interviews appear to be a valuable alternative to in-person interviews, with some sacrifice in personal connection and rapport. Video interviews result in significant time and cost savings for international applicants and have potential implications for the CaRMS process as well.

Sackett KM, Campbell-Heider N, Blyth JB. The evolution and evaluation of videoconferencing technology for graduate nursing education. Comput Inform Nurs. 2004 (Mar-Apr); 22(2):101-6.

Shepherd L, Goldstein D, Whitford H, Thewes B, Brummell V, Hicks M. The utility of videoconferencing to provide innovative delivery of psychological treatment for rural cancer patients: results of a pilot study. J Pain Symptom Manage 2006 (Nov); 32(5):453-61.

Arena J, Dennis N, Devineni T, Maclean R, Meador K. A pilot study of feasibility and efficacy of telemedicine-delivered psychophysiological treatment for vascular headache. Telemed J E Health 2004 (Winter); 10(4):449-54.
The role of THOA in calcium sensitization in human myometrial smooth muscles
Authors: Aguilar Hector , Mitchell B. F. (Peter)
Published: May 2017

Improved understanding of the regulation of contractions of uterine smooth muscle (myometrium) is essential to develop more successful strategies for prevention of premature birth, which remains the most common cause of infant death and disability. Oxytocin (OT) and prostaglandin (PG) F2a are potent myometrial stimulants which induce an increase in intracellular Ca++. This activates myosin light chain kinase (MLCK) and subsequently the cell’s contractile machinery. However, there is poor correlation between the rise in Ca++ and the strength of the myometrial contraction. Contractile strength greatly increases at the time of parturition partly due to Ca++-independent factors that sensitize the muscle to the rise in intracellular Ca++. In vascular smooth muscle, one key regulator in this process of Ca++ sensitization is the monomeric G-protein, RhoA which in turn activates Rho-associated kinase (ROK). Studies in the rat myometrium have shown that RhoA and ROK are involved in enhancing OT-induced contractions. The potential role of the RhoA/ROK system in uterine contractility at the time of parturition has not been investigated in the human myometrium or in human cell lines.

We propose to investigate the role of RhoA/ROK in the human myometrium using molecular cloning techniques. We have constructed expression plasmids for wild type, dominant positive (constitutively active), and dominant negative (constitutively inactive) isoforms of RhoA and synthesized purified proteins using a bacterial (BL21) translation system. These constructs will be introduced into primary and immortalized human myocytes using the protein transduction domain (TAT) derived from the HIV virus, which is capable of introducing whole proteins into mammalian cells. RhoA activation/translocation to the plasma membrane will be visualized using real time confocal microscopy in experiments where the RhoA proteins have been tagged with green fluorescent protein (GFP). Following introduction of the normal and mutant G-proteins, the downstream targets of activated ROK will be assayed for phosphorylation status using near infrared (NIR) fluorescence imaging of western blots or in-cell westerns. These targets include the myosin binding subunit (MBS) of myosin light chain phosphatase (MLCP), and two peptide phosphatase inhibitors of MLCP, CPI-17 and PHI-1. In addition, we propose to measure ROK activity directly using a direct enzyme assay. We will monitor calcium transients using fluorescence microscopy to verify the calcium independence of our measurements. These experiments will determine the role of the RhoA/ROK system in the mechanisms that may determine human uterine contractility. This information may direct new strategies to prevent or treat preterm labour.
Effects of maternal nutrient restriction on placental morphology and insulin-like growth factor system expressions
Authors: Albion C , Dixon S , Nygard K , Reid C , Han V
Published: May 2017

Uteroplacental insufficiency is one of the major causes of fetal growth restriction (FGR) in developed countries. The pathophysiology is likely the result of fetal undernutrition due to the impairment of nutrient and substrate transfer from the mother to the fetus. Fetal undernutrition due to maternal undernutrition is not a major cause of FGR in developed countries compared to developing countries. However, FGR can be reproducibly created in experimental animals by maternal undernutrition, and is commonly utilized to study the pathophysiology of fetal undernutrition in the fetus and the placenta. The insulin-like growth factor (IGF) system is the principal growth factor involved in regulating normal fetal and placental growth and its aberrant expression is associated with the development of FGR. We hypothesized that placenta undergoes adaptive changes in pregnancies with maternal undernutrition, the effects of which are mediated by the IGF system.

Methods: A mouse model of FGR was generated in CD-1 mice using maternal total caloric nutrient restriction. At 6.5 days of pregnancy, mice were randomly assigned to the control group (ad libitum diet) or global nutrient restriction (GNR) diet group (70% of predetermined food intake of each gestational day). FGR can be reproducibly induced in the fetuses without effect in litter size. Placentae were collected at 18.5 days and were fixed in 4% paraformaldehyde. Five mm tissue sections were prepared by standard techniques and were stained with hematoxylin & eosin for morphometry, PAS for glycogen staining, and immunohistochemistry against IGF-I and –II, IGFBP-1, -2 and –3 using specific antisera for cell-specific expression of the IGF system. The morphology of the placentae was analyzed using a computerized image analysis system.

Results: Placentae were significantly smaller in FGR mice compared to controls (94±4 mg SEM vs 72±3 mg SEM). Preliminary results demonstrate changes in FGR mouse placentae tended to be a result of a reduction in spongiotrophoblast layer (p = 0.066, one-tailed t-test) while the labyrinthine trophoblast layer was maintained. Morphometric analysis of the labyrinth demonstrated an increase in the diameter of both maternal and fetal vessels with a reduction in the thickness of the interchorial layer. The IGF-I and –II, IGFBP-1, IGFBP-2 and IGFBP-3 immunoreactivity were all reduced in FGR placentae compared to the controls.

Conclusion: These findings suggest that maternal nutrient restriction induces changes in the placenta that may potentially lead to improved nutrient and substrate transfer from mother to fetus, in an attempt to maintain fetal viability. However, these compensatory changes are not sufficient to maintain growth. These changes may result from the alteration of expression of the IGF system genes.
Global gene expression analyses in early experimental osteoarthritis reveal novel players in articular cartilage degenerations
Authors: Appleton Tom , Usmani Shirine , Pitelka Vasek , Henry Jim , Bernier Suzanne , Beier Frank
Published: May 2017

Introduction: Articular cartilage degeneration is a hallmark of osteoarthritis (OA). We sought to identify dysregulated genes in degenerating cartilage and hypothesized that altered growth factor expression causes cartilage degradation in OA.

Methods: Genome-wide microarray analysis of RNA harvested directly from sham (control) and degenerating articular cartilage was performed using our previously characterized pre-clinical rat model of knee OA1. Known OA genes were validated using RNA samples (real-time PCR) and histological sections (immunofluorescence) from independent animals. Functional studies in chondrocytes and articular cartilage explants investigated the effects of one identified factor (transforming growth factor alpha (TGF-α)) on cartilage degeneration. The effects of TGF-α on primary chondrocyte morphology, proliferation, gene expression, and SOX9 transcription factor expression were assessed.

Results: Dysregulated gene expression profiles in degenerating cartilage included known OA genes2. Microarray expression profiles were consistently validated at RNA and protein levels by alternative methods. Several genes previously unstudied in OA cartilage were upregulated, including growth factors (e.g. TGF-α and kit ligand), cell surface receptors (e.g. endothelin type A receptor), and proteases (e.g. cathepsin S). Functional studies demonstrated that TGF-α alters chondrocyte morphology through re-organization of the actin cytoskeleton. TGF-α also stimulated primary chondrocyte proliferation and chondrocyte cluster formation in cartilage explants. Chondrocyte expression of anabolic genes and total collagen protein levels were reduced by TGF-α, while expression of catabolic factors increased. Finally, TGF-α reduced both the expression of total SOX9 and levels of phosphorylated (active) SOX9.

Conclusions: Our microarray study identified numerous factors previously unstudied in OA cartilage, including increased levels of TGF-α. Functional studies determined that TGF-α promotes cartilage degeneration through chondrocyte proliferation and catabolic factor expression. Further, TGF-α inhibits chondrocyte anabolism, likely through a mechanism involving suppression of SOX9.

References:

1C.T.G. Appleton et al. (2007). Arthritis Res Ther 9(1):R13. 2C.T.G. Appleton et al. (2007), Arthritis Rheum In Press.